Characteristics of peptic ulcer bleeding in cirrhotic patients with esophageal and gastric varices

AbstractUpper gastrointestinal bleeding (UGIB) is common in liver cirrhosis. Although esophageal and gastric varices (EGV) is the main bleeding source, there were still a proportion of patients with peptic ulcer bleeding. Thus, this study aimed to analyze the characteristic of variceal bleeding and peptic ulcer bleeding in liver cirrhosis. Cirrhotic patients with confirmed UGIB by urgent endoscopy from July 2012 to June 2018 were enrolled, and classified into peptic ulcer bleeding group (n = 248) and variceal bleeding group (n = 402). Clinical and endoscopic characteristics, therapeutic efficacy and prognosis were evaluated, and independent risk factors for 42-day morality were determined. The mean age and gender ratio of peptic ulcer bleeding group were higher than those in variceal bleeding group (55.58 ± 11.37 vs. 52.87 ± 11.57, P < 0.01; 4.51:1 vs. 2.87:1, P = 0.023). Variceal bleeding group most commonly presented as red blood emesis and coffee grounds (67.16%), while peptic ulcer group primarily manifested as melena (62.10%). Hepatocellular carcinoma was more prevalent in peptic ulcer group (141 vs. 119, P < 0.01). Albumin level in variceal bleeding group was lower higher (P < 0.01), but serum bilirubin, creatinine and prothrombin time were significantly higher (all P < 0.01). Success rate of endoscopic hemostasis for variceal bleeding and peptic ulcer bleeding was 89.05% and 94.35% (P = 0.021). Univariate and multivariate analysis identified prothrombin time (P = 0.041, OR [95% CI] 0.884 [0.786–0.995]), MELD score (P = 0.000, OR [95% CI] 1.153 [1.073–1.240]), emergency intervention (P = 0.002, OR [95% CI] 8.656 [2.219–33.764]), hepatic encephalopathy before bleeding (P = 0.003, OR [95% CI] 8.119 [2.084–31.637]) and hepatic renal syndrome before bleeding (P = 0.029, OR [95% CI] 3.877 [1.152–13.045]) as the independent predictors for 42-day mortality. Peptic ulcer bleeding should be distinguished from variceal bleeding by clinical and endoscopic characteristics.

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Characteristics of peptic ulcer bleeding in cirrhosis with esophageal and gastric varices

10.21203/rs.2.12787/v1 ◽

2019 ◽

Author(s):

Zheng Lu ◽

Xiaotian Sun ◽

Jingjing Han ◽

Bo Jin ◽

Wenhui Zhang ◽

...

Keyword(s):

Liver Cirrhosis ◽

Peptic Ulcer ◽

Variceal Bleeding ◽

Gastric Varices ◽

Ulcer Bleeding ◽

Common Symptom ◽

Peptic Ulcer Bleeding ◽

Esophageal And Gastric Varices ◽

Independent Risk Factors ◽

Endoscopic Characteristics

Abstract Background Upper gastrointestinal bleeding (UGIB) is common in liver cirrhosis. Although esophageal and gastric varices (EGV) is the main bleeding source, there were still a proportion of patients with peptic ulcer bleeding, which has been easily neglected. Thus, this study aimed to analyzed and compared the characteristic of variceal bleeding and peptic ulcer bleeding in liver cirrhosis patients. Methods Cirrhotic patients with confirmed UGIB by urgent endoscopy from July 2012 to June 2018 in our hospital were enrolled, and classified into peptic ulcer bleeding group (n=248) and variceal bleeding group (n=402) based on the bleeding cause. The clinical and endoscopic characteristics, therapeutic efficacy and prognosis were evaluated and compared, and independent risk factors for 42-day morality in peptic ulcer bleeding in cirrhotic EGV patients were determined. Results Compared with variceal bleeding group, peptic ulcer bleeding group were older (55.58±11.37 vs. 52.87±11.57, P<0.01) and more stable, and the most common symptom was melena. Hepatocellular carcinoma was more prevalent in peptic ulcer group (141 vs. 119, P<0.01). The success rate of endoscopic hemostasis for variceal bleeding and peptic ulcer bleeding was 89.05% and 94.35%, respectively (P=0.021). Univariate and multivariate analysis identified emergency intervention (P=0.018, OR [95% CI] 11.270 [1.503-84.501]), hepatic encephalopathy before bleeding (P=0.034, OR [95% CI] 6.831 [1.159-40.255]) and hepatic renal syndrome before bleeding (P=0.013, OR [95% CI] 8.482 [1.568-45.869]) as three independent predictors for 42-day mortality. Conclusion Peptic ulcer bleeding should be distinguished from variceal bleeding by clinical and endoscopic characteristics, and urgent endoscopic treatment is needed once diagnosed.

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Various aspects of peptic ulcer in patients with liver cirrhosis

Medicinski pregled ◽

10.2298/mpns1802027s ◽

2018 ◽

Vol 71 (1-2) ◽

pp. 27-32

Author(s):

Zeljka Savic ◽

Dragomir Damjanov ◽

Vladimir Vracaric ◽

Dijana Kosijer ◽

Dimitrije Damjanov ◽

...

Keyword(s):

Helicobacter Pylori ◽

Liver Cirrhosis ◽

Peptic Ulcer ◽

Helicobacter Pylori Infection ◽

Ulcer Bleeding ◽

Peptic Ulcer Bleeding ◽

Cirrhotic Patients ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Bleeding Ulcers

Introduction. The occurrence of peptic ulcer in patients with liver cirrhosis is intriguing due to its frequency and complexity. The aim of the present study was to investigate the incidence of peptic ulcer in patients with liver cirrhosis. Results. It was found that in these patients the usual aggressive factors of the gastric environment do not play a major role in ulcerogenesis; however, researches noticed the importance of reduced mucosal defense which, in portal hypertension, has the features of hypertensive portal gastropathy. The presence of Helicobacter pylori infection in these patients is lower, compared to other patients with peptic ulcer. The prevalence of Helicobacter pylori infection decreases with the severity of liver cirrhosis. Non-steroidal anti-inflammatory drugs play an important role in peptic ulcer bleeding in cirrhotic patients, but the data are limited and contradictory. Peptic ulcer bleeding is the most frequent etiology of nonvariceal bleeding and it is associated with a great number of complications. Conclusion. Helicobacter pylori infection cannot be considered the key risk factor for the development of peptic ulcer in patients with liver cirrhosis. The role of non-steroidal anti-inflammatory drugs is accepted, although the data are controversial. The treatment of peptic ulcer in cirrhotic patients is identical to the treatment of peptic ulcer in patients without liver cirrhosis, except in cases of bleeding ulcers. There are specific therapeutic protocols for peptic ulcer bleeding in patients with liver cirrhosis.

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