الفهرس 
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Abstract
Egypt has the largest burden of HCV infection in the world, with a 10% prevalence of chronic HCV infection among persons aged 15-59 years. This infection is the main cause of liver cirrhosis in Egypt. Sixty percent of cirrhotic patients develop esophageal varices and thirty percent suffer from variceal hemorrhage.
Bleeding esophageal varices is the gravest complication of liver cirrhosis, with a high mortality and each variceal bleeding attack carries a mortality rate of 17%-57%, these data reflects the importance to find a reliable noninvasive method for detection of esophageal varices especially when the number of patients requiring endoscopic screening is in millions, which is the situation in Egypt.
Studying portal hemodynamics by using duplex Doppler is a non-invasive, reliable and a relatively cheap method for evaluating the portal hemodynamic changes in cirrhotic patients; also it can be used in studying the effect and prognosis of different methods and drugs used to reduce portal hypertension.
In the past decades, many studies were done to find the best method to prevent variceal bleeding in cirrhotic patients.
The recommendations of the American College of Gastroenterology state that combined endoscopic and pharmacological therapy is the most effective for secondary prophylaxis.
Whereas the Baveno Consensus conference recommends either β-blockers, banding ligation or both; the experts add that combined therapy is probably the best treatment.
The aim of this work was to study the portal hemodynamics (measured by Doppler ultrasound) in cirrhotic patients with esophageal varices admitted for band ligation with or without the administration of oral non selective beta blockers (propranolol).
A total of 50 patients who were eligible for the study ( patients with cirrhosis, esophageal varices and have no contraindications for propranolol) were classified into two groups;
Group A: Twenty five patients on oral propranolol (as a non-selective β-blocker) combined with endoscopic variceal band ligation.
Group B: Twenty five patients on endoscopic variceal band ligation alone without oral propranolol.
Beside full history, clinical and laboratory investigations, Doppler ultrasound was done for all patients at the start of the study then repeating it after around six month for reporting the hemodynamic changes in both groups.
The results of this study showed that:
1. Regarding the Portal vein diameter (PVD) before and after 6 months; Before the start of the treatment, group (A), the portal vein diameter (PVD) ranged between 1.330-1.600 with the mean of 1.4810.077, while group (B), the PVD ranged between 1.330-1.600 with the mean of 1.4420.084. There were no statistical significant differences between the two groups before the start of the treatment regarding PVD. After 6 months of treatment, group (A), PVD ranged between 1.208-1.453 with the mean of 1.3450.07, while group (B) ranged between 1.284-1.581 with the mean of 1.4250.083. There were statistical significant differences between the two studied groups after. (P=0.001).
2. Regarding the Portal vein flow velocity (VEL) before and after 6 months; Before the start of the treatment, group (A), the portal vein flow velocity (VEL) ranged between 7-10.8 with the mean of 8.8941.009, while group (B), the VEL ranged between 8-10.3 with the mean of 8.9620.683. There were no statistical significant differences between the two groups before the start of the treatment regarding VEL. After 6 months of treatment, group (A), VEL ranged between 6.342-9.785 with the mean of 8.0580.914, while group (B) ranged between 7.84-10.094 with the mean of 8.7830.670. There were statistical significant differences between the two studied groups after. (P=0.001).
3. Regarding the Portal flow in L/M Before and after 6 months;
Before the start of the treatment, group (A), the portal vein flow ranged between 0.771-1.00 with the mean of 0.9130.054, while group (B), the flow ranged between 0.703-1.00 with the mean of 0.8760.070. There were no statistical significant differences between the two groups before the start of the treatment regarding portal flow. After 6 months of treatment, group (A), flow ranged between 0.698-0.905 with the mean of 0.8260.049, while group (B) ranged between 0.688-0.984 with the mean of 0.8560.068. There were statistical significant differences between the two studied groups after treatment. (P=0.034).
4. Regarding the Congestion index (CI) before and after 6 months;
Before the start of the treatment, group (A), the congestion index (CI) ranged between 0.134-0.262 with the mean of 0.1980.040, while group (B), the CI ranged between 0.1288-0.2480 with the mean of 0.1850.033. There were no statistical significant differences between the two groups before the start of the treatment regarding CI. After 6 months of treatment, group (A), CI ranged between 0.121-0.237 with the mean of 0.1800.036, while group (B) ranged between 0.126-0.242 with the mean of 0.1810.032. There were no statistical significant differences between the two studied groups. (P=0.436).
In conclusion, both groups reduced the portal hemodynamic parameters, but patients received a combination of band ligation with propranolol showed better results.