Variceal Versus Non-Variceal Etiology of Gastrointestinal Bleeding in Patients With Cirrhosis and Related Secondary Complications

Bravo-Espinoza, I.E.; Pérez-Hernández, J.L.; Lajud-Barquín, F.A.; López-Pérez, R.Y.; Santana-Montes, M.O.; Diego-Salazar, P.M.; Tijera, M.F. Higuera de la

doi:10.1016/j.aohep.2021.100591

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“…In a meta-analysis for non-variceal GI bleeding in cirrhotic patients, the most common causes of upper GI bleeding except variceal bleeding were portal hypertensive gastropathy (PHG) (20–98%) and peptic ulcer disease (40–50%) [ 23 , 24 , 25 ]. In a previous case–control study of 294 cirrhotic patients, the origin (variceal vs. non-variceal) of GI bleeding in cirrhotic patients did not affect the development of other complications and mortality, except for acute renal injury in variceal bleeding [ 26 ]. However, non-variceal GI bleeding with PHG and peptic ulcer disease in cirrhosis patients was difficult to control compared to varix bleeding due to limitations in the use of direct endoscopy therapy in diffuse patterned PHG and poor wound healing due to decreased gastrointestinal mucosal flow [ 27 ].…”

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The Clinical Courses and Prognosis of Cirrhotic Patients after First Acute Decompensation: Prospective Cohort Study

Kim,

Song

et al. 2023

Diagnostics

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Background: The European Foundation for the Study of Chronic Liver Failure (EF-CLIF) consortium suggested that the clinical courses after acute decompensation (AD) stratify the long-term prognosis: stable decompensated cirrhosis (SDC), unstable decompensated cirrhosis (UDC), pre acute-on-chronic liver failure (pre ACLF), and ACLF. However, previous studies included patients with a history of previous AD and had limitations associated with identifying the clinical factors related to prognosis after the first AD. Method: The prospective Korean Acute-on-Chronic Liver Failure (KACLiF) cohort included cirrhotic patients who were hospitalised with first AD between July 2015 and August 2018. We analysed the factors associated with readmission after the first AD and compared the characteristics and prognosis among each subgroup to evaluate the risk factors for the occurrence of pre ACLF after AD. Result: A total of 746 cirrhotic patients who were hospitalised with first AD were enrolled. The subgroups consisted of SDC (n = 565), UDC (n = 29), pre ACLF (n = 28), and ACLF (n = 124). Of note, pre ACLF showed a poorer prognosis than ACLF. The risk factors associated with readmission within 3 months of first AD were non-variceal gastrointestinal (GI) bleeding, hepatic encephalopathy (HE), and high MELD score. Viral aetiology was associated with the occurrence of pre ACLF compared with alcohol aetiology regardless of baseline liver function status. Conclusion: Cirrhotic patients with first AD who present as non-variceal GI bleeding and HE can easily relapse. Interestingly, the occurrence of AD with organ failure within 3 months of first AD (pre ACLF) has worse prognosis compared with the occurrence of organ failure at first AD (ACLF). In particular, cirrhotic patients with viral hepatitis with/without alcohol consumption showed poor prognosis compared to other aetiologies. Therefore, patients with ACLF after AD within 3 months should be treated more carefully and definitive treatment through LT should be considered.

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