Clinical implications of the white nipple sign and its role in the diagnosis of esophageal variceal hemorrhage

Ming Chih Hou, Han Chieh Lin, Benjamin Ing Tiau Kuo, Fa Yauh Lee, C. Schmidt, Shou Dong Lee

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: Differentiation of esophageal variceal hemorrhage from other sources of the GI tract is often difficult. This is a prospective investigation of the significance of the white nipple sign in patients with recent esophageal variceal hemorrhage. Methods: One hundred sixty-six patients with recent variceal hemorrhage were prospectively studied with respect to presence or absence of the white nipple sign and other stigmata of hemorrhage and compared with 100 patients with known varices but without a clinical history of bleeding. Results: The white nipple sign correlated positively with severity of bleeding (patients required more blood transfusion), hematemesis, and signs of shock. Patients with the white nipple sign also tended to undergo emergency endoscopy and have active bleeding at the time of endoscopy. There was no correlation between rebleeding rate after endoscopic therapy and presence of the white nipple sign. Appearance of the white nipple sign was closely related to the timing of endoscopy (p <0.0001). The sensitivity and specificity of the white nipple sign in the diagnosis of esophageal variceal hemorrhage were 21 and 100%, respectively, compared with 100 and 54% for the red color sign. Furthermore, the sensitivity of the white nipple sign increased with shorter times between bleeding and endoscopy. Conclusions: In patients with upper GI bleeding, the white nipple sign suggests that the varices bled recently and that the bleeding was severe. However, it has no predictive value for rebleeding after endoscopic therapy. Earlier endoscopy (i.e., within 24 h of bleeding) is suggested to improve the diagnostic rate of esophageal variceal hemorrhage.

Original languageEnglish (US)
Pages (from-to)2103-2109
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume91
Issue number10
StatePublished - Oct 1996
Externally publishedYes

Fingerprint

Nipples
Hemorrhage
Endoscopy
Bleeding Time
Varicose Veins
Hematemesis
Christianity
Blood Transfusion
Gastrointestinal Tract
Shock
Emergencies
Color

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Clinical implications of the white nipple sign and its role in the diagnosis of esophageal variceal hemorrhage. / Hou, Ming Chih; Lin, Han Chieh; Kuo, Benjamin Ing Tiau; Lee, Fa Yauh; Schmidt, C.; Lee, Shou Dong.

In: American Journal of Gastroenterology, Vol. 91, No. 10, 10.1996, p. 2103-2109.

Research output: Contribution to journalArticle

Hou, Ming Chih ; Lin, Han Chieh ; Kuo, Benjamin Ing Tiau ; Lee, Fa Yauh ; Schmidt, C. ; Lee, Shou Dong. / Clinical implications of the white nipple sign and its role in the diagnosis of esophageal variceal hemorrhage. In: American Journal of Gastroenterology. 1996 ; Vol. 91, No. 10. pp. 2103-2109.
@article{65a1f16bd38e411cbb4c9a644b8867c6,
title = "Clinical implications of the white nipple sign and its role in the diagnosis of esophageal variceal hemorrhage",
abstract = "Objective: Differentiation of esophageal variceal hemorrhage from other sources of the GI tract is often difficult. This is a prospective investigation of the significance of the white nipple sign in patients with recent esophageal variceal hemorrhage. Methods: One hundred sixty-six patients with recent variceal hemorrhage were prospectively studied with respect to presence or absence of the white nipple sign and other stigmata of hemorrhage and compared with 100 patients with known varices but without a clinical history of bleeding. Results: The white nipple sign correlated positively with severity of bleeding (patients required more blood transfusion), hematemesis, and signs of shock. Patients with the white nipple sign also tended to undergo emergency endoscopy and have active bleeding at the time of endoscopy. There was no correlation between rebleeding rate after endoscopic therapy and presence of the white nipple sign. Appearance of the white nipple sign was closely related to the timing of endoscopy (p <0.0001). The sensitivity and specificity of the white nipple sign in the diagnosis of esophageal variceal hemorrhage were 21 and 100{\%}, respectively, compared with 100 and 54{\%} for the red color sign. Furthermore, the sensitivity of the white nipple sign increased with shorter times between bleeding and endoscopy. Conclusions: In patients with upper GI bleeding, the white nipple sign suggests that the varices bled recently and that the bleeding was severe. However, it has no predictive value for rebleeding after endoscopic therapy. Earlier endoscopy (i.e., within 24 h of bleeding) is suggested to improve the diagnostic rate of esophageal variceal hemorrhage.",
author = "Hou, {Ming Chih} and Lin, {Han Chieh} and Kuo, {Benjamin Ing Tiau} and Lee, {Fa Yauh} and C. Schmidt and Lee, {Shou Dong}",
year = "1996",
month = "10",
language = "English (US)",
volume = "91",
pages = "2103--2109",
journal = "American Journal of Gastroenterology",
issn = "0002-9270",
publisher = "Nature Publishing Group",
number = "10",

}

TY - JOUR

T1 - Clinical implications of the white nipple sign and its role in the diagnosis of esophageal variceal hemorrhage

AU - Hou, Ming Chih

AU - Lin, Han Chieh

AU - Kuo, Benjamin Ing Tiau

AU - Lee, Fa Yauh

AU - Schmidt, C.

AU - Lee, Shou Dong

PY - 1996/10

Y1 - 1996/10

N2 - Objective: Differentiation of esophageal variceal hemorrhage from other sources of the GI tract is often difficult. This is a prospective investigation of the significance of the white nipple sign in patients with recent esophageal variceal hemorrhage. Methods: One hundred sixty-six patients with recent variceal hemorrhage were prospectively studied with respect to presence or absence of the white nipple sign and other stigmata of hemorrhage and compared with 100 patients with known varices but without a clinical history of bleeding. Results: The white nipple sign correlated positively with severity of bleeding (patients required more blood transfusion), hematemesis, and signs of shock. Patients with the white nipple sign also tended to undergo emergency endoscopy and have active bleeding at the time of endoscopy. There was no correlation between rebleeding rate after endoscopic therapy and presence of the white nipple sign. Appearance of the white nipple sign was closely related to the timing of endoscopy (p <0.0001). The sensitivity and specificity of the white nipple sign in the diagnosis of esophageal variceal hemorrhage were 21 and 100%, respectively, compared with 100 and 54% for the red color sign. Furthermore, the sensitivity of the white nipple sign increased with shorter times between bleeding and endoscopy. Conclusions: In patients with upper GI bleeding, the white nipple sign suggests that the varices bled recently and that the bleeding was severe. However, it has no predictive value for rebleeding after endoscopic therapy. Earlier endoscopy (i.e., within 24 h of bleeding) is suggested to improve the diagnostic rate of esophageal variceal hemorrhage.

AB - Objective: Differentiation of esophageal variceal hemorrhage from other sources of the GI tract is often difficult. This is a prospective investigation of the significance of the white nipple sign in patients with recent esophageal variceal hemorrhage. Methods: One hundred sixty-six patients with recent variceal hemorrhage were prospectively studied with respect to presence or absence of the white nipple sign and other stigmata of hemorrhage and compared with 100 patients with known varices but without a clinical history of bleeding. Results: The white nipple sign correlated positively with severity of bleeding (patients required more blood transfusion), hematemesis, and signs of shock. Patients with the white nipple sign also tended to undergo emergency endoscopy and have active bleeding at the time of endoscopy. There was no correlation between rebleeding rate after endoscopic therapy and presence of the white nipple sign. Appearance of the white nipple sign was closely related to the timing of endoscopy (p <0.0001). The sensitivity and specificity of the white nipple sign in the diagnosis of esophageal variceal hemorrhage were 21 and 100%, respectively, compared with 100 and 54% for the red color sign. Furthermore, the sensitivity of the white nipple sign increased with shorter times between bleeding and endoscopy. Conclusions: In patients with upper GI bleeding, the white nipple sign suggests that the varices bled recently and that the bleeding was severe. However, it has no predictive value for rebleeding after endoscopic therapy. Earlier endoscopy (i.e., within 24 h of bleeding) is suggested to improve the diagnostic rate of esophageal variceal hemorrhage.

UR - http://www.scopus.com/inward/record.url?scp=0029817459&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029817459&partnerID=8YFLogxK

M3 - Article

VL - 91

SP - 2103

EP - 2109

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

IS - 10

ER -