ENDOSCOPIC FINDINGS OF UPPER GASTROINTESTINAL BLEEDING IN PATIENTS WITH LIVER CIRROSIS

Authors

  • Rania Hadayat Medical Officer,Ayub Teaching Hospital, Abbottabad
  • Attique -ur-Rehman Jehangiri Department of Medicine, Ayub Teaching Hospital, Abbottabad
  • Rahid Gul Department of Medicine, Ayub Teaching Hospital, Abbottabad
  • Adil Naseer Khan Department of Gastroenterology, Ayub Teaching Hospital, Abbottabad
  • Khalid Said Department of Gastroenterology, Ayub Teaching Hospital, Abbottabad
  • Asadullah Gandapur Department of Gastroenterology, Ayub Teaching Hospital, Abbottabad

Abstract

Background: Acute upper gastrointestinal (GI) bleeding is a common medical emergency. A common risk factor of upper GI bleeding is cirrhosis of liver, which can lead to variceal haemorrhage. 30–40% of cirrhotic patients who bleed may have non-variceal upper GI bleeding and it is frequently caused by peptic ulcers, portal gastropathy, Mallory-Weiss tear, and gastro-duodenal erosions. The objective of this study was to determine the frequency of upper gastrointestinal endoscopic findings among patients presenting with upper gastrointestinal bleeding with liver cirrhosis. Methods: This descriptive cross-sectional study was carried out in Gastroenterology & Hepatology Department of Ayub Teaching Hospital, Abbottabad from February 2012 to June 2013. 252 patients diagnosed with cirrhosis, presenting with upper GI bleed, age ≥50 years of either gender, and were included in the study. Non-probability consecutive sampling was used. Endoscopy was performed on each patient and the findings documented. Results: The mean age was 57.84±6.29 years. There were 158 (62.7%) males and 94 (37.3%) females. The most common endoscopic finding was oesophageal varices (92.9%, n=234) followed by portal hypertensive gastropathy (38.9%, n=98) with almost equal distribution among males and females. Gastric varices were found in 33.3% of patients (n=84). Among other non-variceal lesions, peptic ulcer disease was seen in 26 patients (10.3%) while gastric erosions were found in 8 patients (3.2%). Conclusion: In patients with acute upper GI bleeding and liver cirrhosis, the most common endoscopic finding is oesophageal varices, with a substantially higher value in our part of the country, apart from other non-variceal causes.Keywords: Gastrointestinal haemorrhage, liver cirrhosis, oesophageal and gastric varices, endoscopy

References

Shaikh NA, Khatri GK, Bhatty SA, Irfan M. Endoscopic diagnoses in patients with upper gastrointestinal bleeding. Med Channel 2010;16:30–4.

González-González JA, García-Compean D, Vázquez-Elizondo G, Garza-Galindo A, Jáquez-Quintana JO, Maldonado-Garza H. Nonvariceal upper gastrointestinal bleeding in patients with liver cirrhosis. Clinical features, outcomes and predictors of in-hospital mortality. A prospective study. Ann Hepatol 2011;10:287–95.

Laine L. Gastrointestinal Bleeding. In: Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL, Loscalzo J, et al, editors. Harrison’s Principles of Internal Medicine. 18th Ed. New York: McGraw-Hill; 2012:320–3.

Bloom S, Webster G. Acute Upper Gastrointestinal Bleeding. In: Oxford handbook of gastroenterology and hepatology. 1st Ed. Karachi: Oxford University Press; 2006:696–705.

McQuaid KR. Gastrointestinal Disorders. In: Papadakis MA, McPhee SJ, Rabow MW, editors. Current Medical Diagnosis & Treatment. 52nd Ed. New York: McGraw-Hill; 2013:564-661.

Khan A, Ali M, Khan IA, Khan AG. Causes of severe upper gastrointestinal bleeding on basis of endoscopic findings. Post Grad Med Inst 2006;20:154–8.

Garcia-Tsao G, Bosch J. Management of varices and variceal haemorrhage in cirrhosis. N Engl J Med 2010;362:823–32.

Svoboda P, Konecny M, Martinek A, Hrabovsky V, Prochazka V, Ehrmann J. Acute upper gastrointestinal bleeding in liver cirrhosis patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012;156:266–70.

D’Amico G, De Franchis R. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology 2003;38:599–612.

Odelowo OO, Smoot DT, Kim K. Upper gastrointestinal bleeding in patients with liver cirrhosis. J Natl Med Assoc 2002;94:712–5.

Seo YS, Kim YH, Ahn SH, Yu SK, Baik SK, Choi SK, et al. Clinical features and treatment outcomes of upper gastrointestinal bleeding in patients with cirrhosis. J Korean Med Sci 2008;23:635–43.

Romcea AA, Tanțău M, Seicean A, Pascu O. The etiology of upper gastrointestinal bleeding in cirrhotic patients. Clujul Medical 2013; 86:21-3.

Pasha MB, Hashir MM, Pasha AK, Pasha MB, Raza AA, Fatima M. Frequency of esophageal varices in patients with upper gastrointestinal bleeding. Pak J Med Sci 2011; 27:277–81.

Bilal A, Fazal MO, Shaheen M, Qureshi FS, Ali G, Iqbal MI. Frequency of peptic ulcer in patients having decompensated cirrhosis of liver. Ann Punjab Med Coll 2008; 2:35–40.

Nasir N, Nadeem MA, Imran M, Hussain I, Chaudhry NU. Oesophageal varices vs peptic ulcer: A study of 100 patients presenting in Mayo Hospital with upper gastrointestinal bleeding. Pakistan J Gartroenterol 1998;12:58–63.

Khan AG, Khan H, Khattak AK. Upper GI endoscopic findings in cirrhotic patients presenting with upper gastrointestinal bleed. Pak J Gastroenterol 2012;26:16–21.

Khurram M, Khaar HB, Javed S, Hasan Z, Arshad M, Goraya F, et al. Upper GI endoscopic evaluation of 299 patients with clinically compensated cirrhosis. Pak J Gastroenterol 2003;17:12-6.

Yachimski PS, Friedman LS. Gastrointestinal bleeding in the elderly. Nat Clin Pract Gastroenterol Hepatol 2008;5:80–93.

Talafeeh AO, Sameer E, Holy M. Endoscopic findings in upper gastrointestinal bleeding patients at Prince Hashem Hospital. J Royal Med Serv 2004; 11:71-3.

van Leerdam ME. Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol 2008;22:209–24.

Adam T, Javed F, Khan S. Upper gastrointestinal bleeding: An etiological study of 552 cases. J Pak Inst Med Sci 2004;15:845–8.

Khurram M, Javed S, Khaar HB, Goraya F, Hasan Z. Endoscopic evaluation of 2484 patients with upper GI haemorrhage. J Rawal Med Coll 2003; 7:89–91.

Khan MS, Khalid M, Ayub N, Javed M. Seroprevalence and risk factors of Hepatitis C virus (HCV) in Mardan, N.W.F.P. Rawal Med J 2004;29:57-60.

Hashim R, Hussain AB, Rehman K. Seroprevalence of Hepatitis-C virus antibodies among healthy young men in Pakistan. Pak J Med Res 2005;44:140–2.

Iqbal S, Ruknuddin. Liver Cirrhosis in North-West Frontier Province of Pakistan. J Coll Physicians Surg Pakistan 2002;12:289-91.

Farooqi JI, Jafri SM, Najib-ul-Haq, Niaz SK, Hamid S, Abbas Z, et al. Management of variceal bleeding: PSG guidelines 2006. J Pak Med Assoc 2007; 57:505-11.

Primignani M, Carpinelli L, Preatoni P, Battaglia G, Carta A, Prada A, et al. Natural history of portal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscopic Club for the study and treatment of esophageal varices (NIEC). Gastroenterology 2000;119:181–7.

Umar M, Kanwal S, Chohan AR, Chohan S, Baqai HZ, Khaar HB. Pattern of esophageal varices and portal gastropathy in HCV related cirrhosis. Pak J Gastroenterol 2003;17:20–3.

Abbasi A, Bhutto AR, Butt N, Munir S, Dhillo AK. Frequency of portal hypertensive gastropathy and its relationship with biochemical, haematological and endoscopic features in cirrhosis. J Coll Physicians Surg Pak 2011;21:723-6.

Kim T, Shijo H, Kokawa H, Tokumitsu H, Kubara K, Ota K, et al. Risk factors for haemorrhage from gastric fundal varices. Hepatology 1997;25:307-12.

Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: A long-term follow-up study in 568 portal hypertension patients. J Hepatology 1992;16:1343–9.

Christensen E, Fauerholdt L, Schlichting P, Juhl E, Poulsen H, Tygstrup N. Aspects of the natural history of gastrointestinal bleeding in cirrhosis and the effect of prednisone. Gastroenterology 1981;81:944–52.

Garden OJ, Motyl H, Gilmour WH, Utley RJ, Carter DC. Prediction of outcome following acute variceal haemorrhage. Br J Surg 1985;72:91–5.

Shahin WA, Abdel-Baset EZ, Nassar AK, Atta MM, Kabil SM, Murray JA. Low incidence of Helicobacter pylori infection in patients with duodenal ulcer and chronic liver disease. Scand J Gastroenterology 2001;36:479–84.

Kamalaporn P, Sobhonslidsuk A, Jatchavala J, Atisook K, Rattanasiri S, Pramoolsinsap C. Factors predisposing to peptic ulcer disease in asymptomatic cirrhotic patients. Aliment Pharmacol Ther 2005;21:1459–65.

Kantorova I, Svoboda J, Ochmann J, Kozumplik J, Marsová J. [Duplication source of bleeding in patients with esophageal varices]. Rozhl Chir 1997;76:543–7.

Atif MA, Ahmad I. Esophageal varices: major endoscopic finding on upper GI endoscopy. Professional Med J 2008;15:465–8.

Gostout CJ, Viggiano TR, Balm RK. Acute gastrointestinal bleeding from portal hypertensive gastropathy: prevalence and clinical features. Am J Gastroenterol 1993;88:2030–3.

Downloads

Published

2015-06-20

Most read articles by the same author(s)

<< < 1 2