Potential Precipitating Factors of Esophageal Variceal Bleeding: A Case–Control Study

Abstract

Valsalva maneuver-associated activities such as straining during defecation, vomiting, and cough are believed to cause abrupt increase in variceal pressure. Whether these actions can precipitate rupture of esophageal varices (EV) is unknown. The association of EV bleeding with these activities and other potential risk factors such as ingestion of alcohol and non-steroidal anti-infl ammatory drugs was investigated. METHODS:Between January 2003 and May 2009, 240 patients with liver cirrhosis and acute EV bleeding (group A) and 240 matched patients with Child-Pugh ' s class and moderate size EV without bleeding (group B) were included. Each patient was questioned regarding constipation, vomiting, cough, and other potential risk factors in the week prior to index bleeding (group A) or endoscopy (group B) using a standard questionnaire. RESULTS:Group A had more patients with constipation ( n = 44 vs. n = 16, P < 0.001) and higher constipation scores (0.79 ± 1.67 vs. 0.25 ± 0.92, P < 0.001) than group B. Group A also had more patients with vomiting ( n = 60 vs. n = 33, P = 0.002) and higher vomiting scores (3.0 ± 0.86 vs. 1.85 ± 0.87, P < 0.001). No difference in cough existed between the two groups ( n = 77 group A vs. n = 73 group B); however, group A had higher cough scores (5.08 ± 2.70 vs. 3.19 ± 2.23, P < 0.001). Group A had more patients with excessive alcohol consumption in the week preceding inclusion in the study ( n = 58 vs. n = 5, P < 0.001). On multivariate analysis, constipation score and vomiting score and alcohol consumption were independent determinants of fi rst EV bleeding.CONCLUSIONS: Constipation, vomiting, severe coughing, and excessive consumption of alcohol may precipitate rupture of EV. A prospective cohort study is required to clarify the causal relationship between potential precipitating factors and EV bleeding.

Effect of gender on mortality and causes of death in cirrhotic patients with gastroesophageal varices. A retrospective study in Norway

“…Although ALD was associated with poorer prognosis at univariate analysis, we found no difference in cumulative incidence or risk of death without LT according to etiology when controlling for other factors. Interestingly, however, among patients with no previous history of variceal bleeding, alcohol consumption was a strong predictor of first bleeding episode, confirming results from a Taiwanese study [20].…”

Influence of meteorological factors on the seasonal onset of esophagogastric variceal bleeding

“…The risk of esophagogastric variceal bleeding associates with the pressure gradient of hepatic vein, varicose veins grading, red sign and esophagogastric varicose veins [1,2], and the constipation, vomiting, severe cough and alcoholism are the triggers of bleeding [3], while the studies focusing on the influence of season and meteorological factors on the esophagogastric variceal bleeding are less and the results are not unanimous. Tahri and his colleague [4] found that the morbidity of esophagogastric variceal bleeding reached to maximum in winter, OR = 3.2 (95% CI: 1.6 -6.5).…”

Is propofol safe when administered to cirrhotic patients during sedative endoscopy?

“…However, patients are often unwilling to undergo an endoscopic examination without proper sedation. Also, retching or vomiting during nonsedated endoscopic procedures may be associated with an increased risk of incidental variceal bleeding in these patients [4]. Although sedative endoscopy is now a common practice, the safety of the procedure in patients with liver cirrhosis is currently under debate [5].…”