Outcome in decompensated alcoholic cirrhotic patients with acute variceal bleeding

Kotze, U.; Sayed, Rauf; Burmeister, S.; Bernon, M.; Chinnery, Galya

doi:10.7196/samj.5493

Cited by 4 publications

(10 citation statements)

References 16 publications

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“…77 (55.4%) of our study cases. Similar findings have been observed by Kirge et al 20 . Variceal bleeding was observed in 100 (71.9 %) of our study cases.…”

Section: Results;supporting

confidence: 92%

“…Similar findings have been reported by Kirge et al 20 who also reported variceal bleeding significantly more prevalent among patients with Child-Pugh class C. In our study, overall frequency of mortality was 35 (25.2%) in our study cases with liver cirrhosis. Kirge et al 20 reported 20.8 % rate of mortality among cirrhotic patients, these findings are close to that of our study results. Pichilinque et al 21 reported 18.03 % in hospital mortality in patients having liver cirrhosis.…”

Section: Results;supporting

confidence: 92%

“…19 Another study reported 50 years mean age of these patients, which is slightly higher than ours. 20 Child-Pugh class C was more prevalent i.e. 77 (55.4%) of our study cases.…”

Section: Results;mentioning

confidence: 62%

“…Two other studies very high frequencies of male patients than females. 19,20 Mean age of our study cases was 45.50 ± 10.81 years (minimum age was 19 years while maximum was 60 years). Study results have also indicated that majority of our cases were in the range of age groups 41 to 60 years i.e.…”

Section: Results;mentioning

confidence: 80%

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Association of Variceal Bleed With Severity of Liver Cirrhosis at a Tertiary Care Hospital

Zia¹,

Sarwar²,

Asghar³

2019

JMPB

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Background; A major cause of cirrhosis-related morbidity and mortality is the development of variceal bleeding, a direct consequence of portal hypertension. Each episode of active variceal bleeding is associated with 30 percent mortality. This study was planned to determine frequency of variceal bleeding in patients with liver cirrhosis and frequency of in-hospital mortality of these patients in our population. Objective; To determine the frequency of variceal bleed in hospitalized patients with cirrhosis of liver and its outcome in terms of in-hospital mortality. Material and Methods; Consecutive 139 Patient diagnosed with cirrhosis of liver were included in this cross-sectional study from department of Medicine, Bahawal Victoria hospital Bahawalpur. Complete history and physical examination was assessed to document duration of duration of liver disease, ascites, Hepatic encephalopathy, Previous GI bleed and systemic coagulopathy. All the patients had undergone diagnostic upper GI endoscopic examination to document varices. Results; Of these 139 study cases, 77 (55.4 %) were male and 62 (44.6 %) were female. Mean age of our study cases was 45.50 ± 10.81 years. Mean duration of disease (liver cirrhosis) was 3.25 ± 2.32 years. Majority of our study cases i.e. 94 (67.6%) were having liver cirrhosis for the duration of less than 5 years. Child-Pugh class C was more prevalent i.e. 77 (55.4%) of our study cases. Variceal bleeding was observed in 100 (71.9 %) of our study cases. Frequency of mortality was 35 (25.2%) in our study cases with liver cirrhosis, while frequency of mortality in patients with variceal bleeding was seen in 31 (31%). Variceal bleeding was significantly associated with disease severity (p<0.001). Conclusion; Very high frequency of variceal bleeding was observed in patients with liver cirrhosis. In-hospital mortality was significantly more prevalent in patients with variceal bleeding than without bleed. Variceal bleeding was significantly more seen in patients with increasing age, duration of disease and with more severe level of disease (Child Pugh class C). There was no statistically significant difference of bleeding with regards to gender.

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“…77 (55.4%) of our study cases. Similar findings have been observed by Kirge et al 20 . Variceal bleeding was observed in 100 (71.9 %) of our study cases.…”

Section: Results;supporting

confidence: 92%

Section: Results;supporting

confidence: 92%

“…19 Another study reported 50 years mean age of these patients, which is slightly higher than ours. 20 Child-Pugh class C was more prevalent i.e. 77 (55.4%) of our study cases.…”

Section: Results;mentioning

confidence: 62%

Section: Results;mentioning

confidence: 80%

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Association of Variceal Bleed With Severity of Liver Cirrhosis at a Tertiary Care Hospital

Zia¹,

Sarwar²,

Asghar³

2019

JMPB

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“…Up to 20% of VH episodes can be refractory to standard therapy and are associated with increased mortality [4]. This study emphasizes the critical importance of initial control of variceal bleeding during the first endoscopic intervention when active bleeding is present [44][45][46]. While neither method of endoscopic intervention has any effect on portal flow or resistance, the mechanisms of action differ.…”

Section: Discussionmentioning

confidence: 91%

Endoscopic Variceal Ligation Outperforms Injection Sclerotherapyin Controlling Actively Bleeding OesophagealVaricesin Decompensated Cirrhotic Patients: A Real World Comparative Cohort Analysis

2020

Br J Gastroenterol

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Acute variceal bleeding (AVB) is a severe and potentially life-threatening complication in patients with cirrhosis and portal hypertension with mortality rates as high as 20% for the index bleeding event and 10% for subsequent bleeding episodes [1][2][3]. Endoscopic intervention is the first-line treatment to control active bleeding, but around 60% of patients will rebleed after successful initial control if effective follow-up treatment is not provided [4]. Secondary prophylaxis to prevent further variceal bleeding is thus crucial and there is general consensus that patients surviving an initial bleeding episode should enter a longterm eradication and surveillance programme [4].Endoscopic variceal ligation (EVL) has replaced injection sclerotherapy (IST) in most centres as the endoscopic treatment of choice, supported by data from randomised controlled trials (RCTs) which show more rapid eradication of varices with lower rates of rebleeding and fewer oesophageal complications with EVL [5]. However, detailed data on the relative success of each method in controlling AVB with actively bleeding ("spurting") varices are limited. The cohorts analyzed in previous RCTs comparing EVL with IST included only small numbers of patients with active variceal bleeding with conflicting results [5]. In the present study the comparative efficacies of EVL and IST in controlling actively bleeding oesophageal varices in patients in a high volume academic endoscopy referral centre are reported in the largest matched patient cohort to date. Patients and MethodsAdult patients admitted to the Surgical Gastroenterology Unit in Groote Schuur Hospital, Cape Town with variceal bleeding between January 2000 and December 2018 were assessed. Only patients with actively bleeding ("spurting") oesophageal varices who received their first emergency and subsequent procedures in our unit were included in the study (Figure1). The outcome of endoscopic interventions, both emergency and sub-Background and aims: Although endoscopic variceal ligation (EVL) and injection sclerotherapy (IST) are both used to control acute bleeding, no detailed comparative data exist on the relative efficacy and outcome of each method in patients with actively bleeding ("spurting") oesophageal varices. This study compared the efficacy, safety and outcome of EVL with IST in controlling actively bleeding oesophageal varices. Methods:Forty cirrhotic patients with actively bleeding oesophageal varices (BOV) who received EVL were matched and compared with 40 who had IST. Control of variceal bleeding, rebleeding, variceal recurrence, endoscopic complications, eradication and survival were recorded using Baveno assessment criteria. Results: Primary endoscopic failure to control acute bleeding during the first endoscopic intervention occurred in 2.5% in the EVL group and 10% in the IST group. Secondary 5-day failure of bleeding control was 20% in the EVL group and 25% in the IST group. Overall successful endoscopic variceal bleeding during the index admission was similar (EVL 82.5%...

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Sirotik Varis Kanamalarında Tekrar Kanama Belirleyicileri

2023

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Aim Despite recent great progress, higher rates of variceal rebleeding still occur in cirrhotic patients. In order to increase the survival of these patients, it is necessary to optimize the treatment and follow-up of rebleeding and to correct the risk factors that may increase early rebleeding. In this respect, we evaluated the patients' most relevant demographic and routine laboratory features related to variceal early rebleeding. Methods Patients applied to the hospital with variceal bleeding were evaluated for relationship between rebleeding status and erythrocyte suspension needs and laboratory findings as, hemoglobin and platelet level, prothrombine time, creatinine, bilirubin, albumin level and Child-Pugh stage. Results The rebleeding was ascertained in 20 (21%) of our patients during the six week follow-up period after control of the variceal bleeding. In our study, we took into consideration the most relevant routine laboratory and radiological criteria that are closely related to pathogenesis and development of varices and rebleeding in liver cirrhosis. We found that higher Child-Pugh grade, hypo-albuminemia and presence of ascites were significant predictors for variceal rebleeding and other parameters that lower hemoglobin levels were significant predictors. Conclusion The high variceal rebleeding rate could exaggerate the morbidity and mortality burden on cirrhotic patients, so meticulous follow-up is mandatory for those patients to mitigate this complication and increase survival. In summary, after univariate and multivariate analysis of all our potential predictors for variceal rebleeding, we found that the only independent significant predictors were the Child Pugh Grade(p=0,016) and lower hemoglobin levels(p=0,02).

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Outcome in decompensated alcoholic cirrhotic patients with acute variceal bleeding

Cited by 4 publications

References 16 publications

Association of Variceal Bleed With Severity of Liver Cirrhosis at a Tertiary Care Hospital

Association of Variceal Bleed With Severity of Liver Cirrhosis at a Tertiary Care Hospital

Endoscopic Variceal Ligation Outperforms Injection Sclerotherapyin Controlling Actively Bleeding OesophagealVaricesin Decompensated Cirrhotic Patients: A Real World Comparative Cohort Analysis

Sirotik Varis Kanamalarında Tekrar Kanama Belirleyicileri

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