A different view of acute upper gastrointestinal bleeding in liver cirrhosis patients
Published in:
Vnitř Lék 2010; 56(11): 1116-1121
Category:
Original Contributions
Overview
Objectives:
The study focuses predominantly on non‑varicose sources of acute upper gastrointestinal bleeding in liver cirrhosis patients and aims to determine its mortality.
Methods and subjects:
The prospective examination included 137 liver cirrhosis patients with acute upper GIT bleeding. All the patients underwent an endoscopic examination. In case of multiple findings, defining the bleeding source was based on the specialist’s attitude presented as the conclusion of the endoscopic examination.
Results:
The most frequent causes of acute bleeding included oesophagus varices (57.7%), followed by peptic gastric and duodenal ulcers (18.2%), then portal hypertension gastropathy (9.5%), gastric varices (5.1%), reflux oesophagitis (2.9%), Mallory‑ Weiss syndrome (2.9%) and erosive gastropathy (1.5%). The endoscopy of the upper digestive tract resulted in a negative diagnosis in not more than 2.2% of patients. The majority of examinations showed multiple findings in the upper digestive tract, each of which could have been a potential cause of bleeding. Mortality in all bleeding cirrhotic patients reached 14.6%, 18.6% of which were related to the varicose type of bleeding and 7.8% to the non‑varicose type.
Conclusion:
Portal hypertension led to bleeding (caused by varices and portal hypertension gastropathy) in 72.3% of patients, 62.8% patients suffered from purely varicose bleeding, 37.2% patients from non‑varicose bleeding. Mortality was statistically significantly higher on 0.1 level of significance in cases of varicose bleeding in comparison with non‑varicose bleeding. An emphasis should be laid on an early and detailed endoscopic examination leading to an appropriate diagnosis and therapy.
Key words:
liver cirrhosis – portal hypertension – acute bleeding – peptic ulcer – endoscopy
Sources
1. Lata J. Portální hypertenze při jaterní cirhóze a její důsledky. Plzeň: GAAN CZ 2000.
2. Husová L, Juránková J, Lata J et al. Bakteriální infekce ve vztahu ke vzniku a průběhu varikózního krvácení. Vnitř Lék 2007; 53: 1255– 1264.
3. Cameron EA, Pratap JN, Sims TJ et al. Three‑year prospective validation of a pre‑endoscopic risk stratification in patients with acute upper‑ gastrointestinal haemorrhage. Eur J Gastroenterol Hepatol 2002; 14: 497– 501.
4. D’Amico G, De Franchis R. Cooperative Study Group. Upper digestive bleeding in cirrhosis. Post‑therapeutic outcome and prognostic indicators. Hepatology 2003; 38: 599– 612.
5. Odelowo OO, Smoot DT, Kim K. Upper gastrointestinal bleeding in patients with liver cirrhosis. J Natl Med Assoc 2002; 94: 712– 715.
6. Fassio E, Viudez P, Landeira G. Upper digestive hemorrhage in liver cirrhosis: clinical and endoscopic findings. Acta Gastroenterol Latinoam 1992; 22: 181– 186.
7. Gostout CJ, Viggiano TR, Balm RK. Acute gastrointestinal bleeding from portal hypertensive gastropathy: prevalence and clinical features. Am J Gastroenterol 1993; 88: 2030– 2033.
8. Seo YS, Kim ZH, Ahn SH et al. Clinical features and treatment outcomes of upper gastrointestinal bleeding in patients with cirrhosis. J Korean Med Sci 2008; 23: 635– 643.
9. Kantorová I, Svoboda J, Ochmann J et al. Duplicita zdroje krvácení u pacientů s jícnovými varixy. Rozhl Chir 1997; 76: 543– 547.
10. Zaman A, Hapke R, Flora K et al. Prevalence of upper and lower gastrointestinal tract findings in liver transplant candidates undergoing screening endoscopic evaluation. Am J Gastroenterol 1999; 94: 895– 899.
11. Hashizume M, Tanaka K, Inokuchi K. Morphology of gastric microcirculation in cirrhosis. Hepatology 1983; 3: 1008– 1012.
12. Sarfeh IJ, Soliman H, Waxman K et al. Impaired oxygenation of gastric mucosa in portal hypertension. The basis for increased susceptibility to injury. Dig Dis Sci 1989; 34: 225– 228.
13. Svoboda P, Ehrmann J, Klvaňa P et al. Hepatogenní vřed. Čes a Slov Gastroent a Hepatol 2007; 61: 249– 253.
14. Siringo S, Burroughs AK, Bolondi K et al. Peptic ulcer and its course in cirrhosis: an endoscopic and clinical prospective study. J Hepatol 1995; 22: 633– 641.
15. Thomas E, Rosenthal WS, Rymer W et al. Upper gastrointestinal hemorrhage in patients with alcoholic liver disease and esophageal varices. Sources, outcome and short‑term impact on liver function. Am J Gastroenterol 1979; 72: 623– 629.
16. Svoboda P, Ehrmann J, Klvaňa P et al. Endoskopické nálezy v horním trávicím traktu u pacientů s jaterní cirhózou. Vnitř Lék 2007; 53: 968– 971.
17. Machytka E, Ehrmann J, Svoboda P et al. Dlouhodobé sledování pacientů s klinickými známkami krvácení do horní části trávicího traktu a negativním endoskopickým nálezem. Vnitř Lék 2007; 53: 942– 946.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2010 Issue 11
Most read in this issue
- Central hemiparesis as manifestation of systemic vasculitis
- Autoimmune polyendocrine syndrome type 2 associated with autoimmune hypophysitis and coeliac disease
- Lymphoma‑like course in aggressive adult multisystem Langerhans cell histiocytosis and the benefit of PET/ CT imaging in evaluation of diffuse metabolic activity of lung parenchyma
- Determination of the progression of prostate cancer using RT‑PCR method