Vnitr Lek 2010, 56(11):1116-1121

A different view of acute upper gastrointestinal bleeding in liver cirrhosis patients

P. Svoboda^1,*, J. Ehrmann², P. Klvaňa¹, E. Machytka¹, M. Rydlo¹, V. Hrabovský¹

¹ Interní klinika FN Ostrava, přednosta doc. MUDr. Arnošt Martínek, CSc.

² II. interní klinika Lékařské fakulty UP a FN Olomouc, přednosta doc. MUDr. Vlastimil Procházka, Ph.D.

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.

Keywords: liver cirrhosis; portal hypertension; acute bleeding; peptic ulcer; endoscopy

Received: April 7, 2010; Accepted: July 8, 2010; Published: November 1, 2010  Show citation