Background: Serotonin or 5-hydroxytryptamine (5-HT) is known to regulate several key aspects of liver biology including hepatic blood flow, innervation and wound healing, so this study aimed to determine the role of free serotonin concentration in serum as non-invasive marker in the prediction of esophageal and fundal varices in cirrhotic patients. Methods: The study included seventy cirrhotic patients with hepatitis C virus and fifteen apparently healthy subjects as a control group. Patients were further sub classified according to upper Gastrointestinal Endoscopy into three groups (group A: 30 patients with no OV, group B: 29 patients with OV, group C: 11 patients with OV and fundal varices). All subjects were subjected to full history taking, clinical examination and laboratory investigations including CBC, liver and renal function tests and serum-free serotonin by ELISA technique. Results: The mean serum free serotonin level showed a gradual increase in chirotic patients (group A) with the highest level in oesophageal and fundal varices (94.04±8.51 ng/ ml), followed by patients with oesophagal varices only (group B) (39.2±18.38 ng/ ml), and both groups were significantly increased than the patient group with no oesophageal varices (group C). There was a positive correlation between serum serotonin level and serum creatinin level, presence and grading of oesophagal varices and the presence of fundal varices. Free serum serotonin at a cutoff value 32.2 ng/ml had a sensitivity of 72% and a specificity of 60% and AUC=0.721 to in prediction of OV, also free serum serotonin at a cutoff value 79.1ng/ml had a sensitivity of 100% and a specificity of 96.6% and AUC=0.99 to differentiate patients with oesophagal and fundal varices. Free serum serotonin at a cutoff value of 28.4ng/ml had a sensitivity of 55% and a specificity of 25% with AUC=0.27 in the prediction of oesophagal varices grades. Applying multivariate analysis, only serotonin and HB level were independent predictors for oesophagal varices. Conclusion: Free serotonin level could be used as a serum non-invasive marker
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of presence of gastro-oesophageal varices which may help in reducing unnecessary endoscopies, but it could not discriminate between the grades of oesophageal varices |
