Bleeding Esophagogastric Varices

Dagradi, Angelo E.

doi:10.1001/archsurg.1966.01320240132029

Cited by 77 publications

(13 citation statements)

References 6 publications

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“…Further, it has been suggested that portal pressure may decrease after variceal hemorrhage in cirrhotic patients (6). In agreement with previous studies assessing portal pressure by hepatic vein catheterization (21,23) or by other means (5, 24, 25), we found a significantly higher portal pressure in patients with varices when compared to those without. However, portal pressure in these groups overlapped, which may suggest a partial decompression of portal pressure through varices (26).…”

Section: Discussionsupporting

confidence: 92%

Prognostic indicators in alcoholic cirrhotic men

Gluud¹,

Henriksen²

1988

Hepatology

149

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The relationships between portal pressure, liver function and clinical variables on one hand and development of variceal hemorrhage and death on the other were investigated in 58 men with newly diagnosed alcoholic cirrhosis. Portal pressure was determined during hepatic vein catheterization as wedged minus free hepatic vein pressure, and median pressure was 14 mm Hg (range = 3 to 26 mm Hg). Fourteen of 31 patients (45%) had esophageal varices at upper gastrointestinal endoscopy (the size being considered large in nine patients). During follow-up (median = 31 months; range = 2 to 51 months), 12 patients (21%) developed variceal hemorrhage. Applying Cox's regression analysis, information about previous variceal bleeding (p = 0.0046), large varices at endoscopy (p = 0.012), hepatic vein pressure gradient (p = 0.0056) and indocyanine green clearance (p = 0.038) all contained significant prognostic information regarding development of variceal hemorrhage, even when easily obtained variables with known prognostic information were included [modified Child-Turcotte's criteria and incapacitation index (a weighted sum of days without normal health)]. During follow-up, 17 patients (29%) died. Applying Cox's regression analysis, large varices at endoscopy (p = 0.012) and hepatic vein pressure gradient (p = 0.019) contained significant prognostic information regarding death, in addition to the information contained in the modified Child-Turcotte's criteria and incapacitation index. In conclusion, prediction of prognosis in alcoholic cirrhotic men may be significantly improved by information about size of esophageal varices and level of portal pressure.

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Section: Discussionsupporting

confidence: 92%

Prognostic indicators in alcoholic cirrhotic men

Gluud¹,

Henriksen²

1988

Hepatology

149

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“…Esophageal varices were docu mented by endoscopy in 15 patients, 11 of whom had severe bleeding and of these 5 died. The degree of var ices tension was established according to the classifica tion of D agradi et al [5].…”

Section: Methodsmentioning

confidence: 99%

Bleeding in Cirrhotic Patients: A Precipitating Factor due to Intravascular Coagulation or to Hepatic Failure?

Bertaglia¹,

Belmonte²,

Vertolli³

et al. 1983

Pathophysiol Haemos Thromb

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In 24 cirrhotic patients at different stages of hepatic failure, factor VIII: C (F VIIl·C), factor VIΠR:AG (F VIIIR:AG), factor VIII AG/C ratio (F VIII AG/C), and serum fibrin-fibrinogen degradation products (FDP) were investigated. In 11 of the 24 patients, several instances of gastrointestinal bleeding due to esophageal varices rupture were documented and 5 patients died of unarrestable bleeding. In our study, we evaluated whether the cause of bleeding was the development of intravascular coagulation or the severity of hepatic failure. A statistically significant difference between F VIIl·C, F VIIIR:AG/C ratio, and serum FDP was found in bleeding in comparison with non-bleeding patients. An inverse correlation between the F VIII :C plasma level and serum FDP as well as a direct correlation between F VIII AG/C ratio and serum FDP in the group of bleeding patients were also found. These data seem to suggest a hypercoagulable state which was more significant in the 5 patients who died owing to bleeding. Furthermore, only 1 of these patients had severe hepatic failure. From this study it appears that, in cirrhotic patients, bleeding is related more to the appearance of disseminated intravascular coagulation, as a consequence of both hemodynamic and endothelial changes, than to the degree of hepatic failure itself.

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“…At endoscopy esophageal varices were demonstrated in 18 patients and graded according to the classification of Dagradi et al [13,14] (Table 1). In 2 patients no varices were identified although they were seen at PTP 8 and 17 days following endoscopy.…”

Section: Resultsmentioning

confidence: 99%

“…At phlebography we found no difference in size and number Of varices between the patients in groups III and V according to the classification of Dagradi etal. [13,14] (Figs. 4 and 5).…”

Section: Discussionmentioning

confidence: 99%

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A comparative study of esophageal varices by endoscopy and percutaneous transhepatic esophageal phlebography

Hoevels

Joelsson

1979

Gastrointest Radiol

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Twenty patients with portal hypertension due to cirrhosis were examined by esophagoscopy and percutaneous transhepatic esophageal phlebography. Esophageal varices were found in 18 cases at endoscopy and in 19 cases at esophageal phlebography. There was little correlation between the findings of the two methods with respect to the size and number of esophageal varices. At endoscopy the subepithelial and submucosal varices were reliably detected. At esophageal phlebography differentiation between intrinsic (i.e. subepithelial and submucosal veins) and peri-esophageal veins was not possible. Negative findings at esophageal phlebography do not rule out esophageal varices.

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Bleeding Esophagogastric Varices

Cited by 77 publications

References 6 publications

Prognostic indicators in alcoholic cirrhotic men

Prognostic indicators in alcoholic cirrhotic men

Bleeding in Cirrhotic Patients: A Precipitating Factor due to Intravascular Coagulation or to Hepatic Failure?

A comparative study of esophageal varices by endoscopy and percutaneous transhepatic esophageal phlebography

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