Acute upper gastrointestinal bleeding in liver cirrhosis patients

Abstract

Objectives. This study focuses on the etiology of acute upper gastrointestinal (GIT) bleeding in liver cirrhosis patients. Methods. A prospective examination of 137 liver cirrhosis patients with acute upper GIT bleeding. All patients underwent endoscopic examination and in the case of multiple findings, definition of the source of bleeding was based on the endoscopic report. Results. The most frequent causes of acute bleeding were: oesophageal varices (57.7%), peptic gastric and duodenal ulcers (18.2%), portal hypertension gastropathy (9.5%), gastric varices (5.1%), reflux oesophagitis (2.9%), Mallory-Weiss syndrome (2.9%) and erosive gastropathy (1.5%). A negative diagnosis was made in not more than 2.2% of patients. The majority of cases showed multiple findings in the upper digestive tract, each of which was a potential cause of bleeding. The mortality in all bleeding cirrhotic patients was 14.6%, 18.6% of which occurred in the varicose type of bleeding and 7.8% in the non-varicose type. Conclusions. Portal hypertension led to bleeding caused by varices and portal hypertension gastropathy in 72.3% of patients, 62.8% of patients suffered from purely varicose bleeding and 37.2% from non-varicose bleeding. Early, detailed endoscopic examination leading to appropriate diagnosis and treatment is of paramount importance.

Spectrum of upper gastrointestinal bleed in patients with cirrhosis of liver

“…Rebleeding after primary hemostasis within 14 days was higher with variceal group compared to that with non variceal group ( 30 % vs. 10 %). Rebleeding rate during hospitalization was, however only marginally higher in variceal bleeding group compared to non variceal bleed group (18.9% vs. 17.2%) in the study by Svoboda et al 6 which is in contrary to the present study. Mortality during hospitalization was higher with variceal bleed group compared to that with non variceal bleed group (27.5 % vs. 7.5%) in the present study.…”

“…Duodenal ulcers were seen more commonly than gastric ulcers. Peptic ulcers with predominance of duodenal ulcers were also noted in studies by Svoboda et al 6 , Romcea et al 7 and Gonzalez et al 11 The various aetiologies of non variceal bleed in some series has been highlighted in table 6. All these studies suggest that peptic ulcer is the commonest cause of non variceal UGI bleed in cirrhosis of liver.…”

“…Studies by Svoboda et al, 6 Romcea et al 7 , Olajide et al 8 , also have highlighted male predominance of UGI bleed in cirrhosis . Mean age of cirrhotic patients with UGI bleed in this present study was 53.4 years which is almost similar to those reported by Svoboda et al 6 (mean age of 56.9 yrs ) and Romcea et al 7 (mean age 56.8 years). However, Olajide et al 8 has reported a lesser mean age of 48.5 years.…”

“…7,9,10 The most frequent aetiology of upper GI bleed in cirrhosis was rupture of esophageal varices in eighty (66.7 %) patients in our study. Variceal bleed accounted 57.7%, 73% and 50% of acute UGI bleed in cirrhotics in their studies by Svoboda et al 6 ,Romcea et al 7 and Olajide et al 8 respectively.…”

Frequency, Determinants and Outcome of Upper Gastrointestinal Bleed among Patients with Liver Cirrhosis

“…Present study documented significant association of esophageal varices (p=0.000) and gastric varices (p=0.001) as a determinant of UGIB. Similar results were noted in the studies conducted by Odelowo et al 26 , Seo et al 27 and Svoboda et al 18 indicating presence of varices in both esophagus and stomach was significantly associated with UGIB.…”