Seasonal variation in acute variceal upper gastrointestinal tract bleeding: Experience of one decade from Northern India

Background: There have been several reports of seasonal variations in the incidence of esophageal variceal bleeding but the data available from this part of the world is scanty. Aims and Objective: We aimed to study whether monthly and seasonal climatic changes during the year have an influence on the incidence of variceal bleeding in our setting and whether a particular time in the year can be defined as a high-risk period for variceal bleed. Materials and Methods: Data of all the patients with diagnosis of acute variceal upper gastrointestinal bleed who presented to our endoscopy centre from January 2010 to December 2019 was retrieved and analysed. The demographic data, clinical presentations and seasonal and monthly variation was analysed. Results: Out of a total of 10200 patients presenting with upper gastrointestinal bleed during the study time period, 530 patients had a diagnosis of variceal bleed after esophagogastroduodenoscopy (EGD). The majority of variceal bleed patients (48.5%) were seen between May to August months of the year. Conclusions: Contrary to the most of the literature which shows increased frequency of variceal bleed during winters, our patients bleed more during the months of May and August. This could be explained on the basis of unique socio-cultural and demographic pattern of this part of the world.

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CLINICAL UTILITY OF RISK SCORES IN VARICEAL BLEEDING

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201900000-54 ◽

2019 ◽

Vol 56 (3) ◽

pp. 286-293

Author(s):

Sanjay CHANDNANI ◽

Pravin RATHI ◽

Suhas Sudhakarrao UDGIRKAR ◽

Nikhil SONTHALIA ◽

Qais CONTRACTOR ◽

...

Keyword(s):

Blood Transfusion ◽

Variceal Bleeding ◽

Risk Scores ◽

Gastrointestinal Bleed ◽

Variceal Bleed ◽

Upper Gastrointestinal Bleed ◽

Serum Bicarbonate Level ◽

Study Characteristics ◽

Common Etiology ◽

Upper Gastrointestinal

ABSTRACT BACKGROUND: Variceal bleeding remains important cause of upper gastrointestinal bleed. Various risk scores are used in risk stratification for non-variceal bleed. Their utility in variceal bleeding patients is not clear. This study aims to compare probability of these scores in predicting various outcomes in same population. OBJECTIVE: This study aims to compare probability of these scores in predicting various outcomes in same population. To study characteristics and validate AIMS65, Rockall, Glasgow Blatchford score(GBS), Progetto Nazionale Emorragia Digestiva (PNED) score in variceal Upper Gastrointestinal Bleed (UGIB) patients for predicting various outcomes in our population. METHODS: Three hundred subjects with UGIB were screened prospectively. Of these 141 patients with variceal bleeding were assessed with clinical, blood investigations and endoscopy and risk scores were calculated and compared to non-variceal cases. All cases were followed up for 30 days for mortality, rebleeding, requirement of blood transfusion and need of radiological or surgical intervention. RESULTS: Variceal bleeding (141) was more common than non variceal (134) and 25 had negative endoscopy. In variceal group, cirrhosis (85%) was most common etiology. Distribution of age and sex were similar in both groups. Presence of coffee coloured vomitus (P=0.002), painless bleed (P=0.001), edema (P=0.001), ascites (P=0.001), hemoglobin <7.5 gms (P<0.001), pH<7.35 (P<0.001), serum bicarbonate level <17.6 mmol/L (P<0.001), serum albumin<2.75 gms% (P<0.001), platelet count <1.2 lacs/µL (P<0.001), high INR 1.35 (P<0.001), BUN >25mmol/L (P<0.001), and ASA status (P<0.001), high lactate >2.85 mmol/L (P=0.001) were significant. However, no factor was found significant on multivariate analysis. Rockall was found to be significant in predicting mortality and rebleed. AIMS65 was also significant in predicting mortality. GBS was significant in predicting blood transfusion and need of intervention. PNED score was significant in all events except mortality. CONCLUSION: All four scores had lower predictive potential in predicting events in variceal bleed. However, AIMS65 & Rockall score were significant in predicting mortality, while GBS in predicting need of transfusion and intervention. PNED score was significant in all events except mortality.

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Esophageal Variceal Bleeding as the First Manifestation of COVID-19 Infection: A Case Report

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol07-i01/1326 ◽

2022 ◽

Vol 7 (01) ◽

pp. 41-45

Author(s):

Christos Sotiropoulos, MD, MSc ◽

Eftichia Sakka, MD ◽

Georgios Theocharis, MD, PhD ◽

Konstantinos Thomopoulos, MD, PhD

Keyword(s):

Liver Cirrhosis ◽

Case Report ◽

Variceal Bleeding ◽

Clinical Manifestations ◽

Polymerase Chain Reaction Test ◽

Variceal Hemorrhage ◽

Esophageal Variceal ◽

Esophageal Variceal Bleeding ◽

Wide Range ◽

Upper Gastrointestinal

Liver cirrhosis is a defined liver disease with a wide range of clinical manifestations. Variceal bleeding is the main source of gastrointestinal hemorrhage among cirrhotic patients induced by several factors, such as alcohol consumption or infections. This is a report of a cirrhotic patient presenting with esophageal variceal bleeding in the context of COVID-19 infection. We report the case of a 53-year-old patient with liver cirrhosis and multifocal hepatocellular carcinoma presenting with upper gastrointestinal bleeding as the first manifestation of COVID-19 infection. Upon admission, the patient had no symptoms suggestive of a respiratory tract infection or any contact with positive SARS-CoV-2 individual and upper gastrointestinal endoscopy revealed variceal hemorrhage. After a few hours the patient manifested with fever, cough and dyspnea and a SARS-CoV-2 polymerase chain reaction test obtained was positive. The patient was initially treated with endoscopic band ligation and transferred in the COVID-19 infection clinic, where after a few days of hospitalization he passed away. The devastating pandemic of coronavirus disease 2019 had altered the pathophysiology and clinical presentation of several chronic diseases. This case report suggests that coronavirus disease as a potential triggering factor of variceal bleeding.

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Spectrum of upper gastrointestinal bleed in patients with cirrhosis of liver

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v13i3.17938 ◽

2017 ◽

Vol 13 (3) ◽

pp. 318-322

Author(s):

Subash Bhattarai ◽

Khus Raj Dewan ◽

Gaurav Shrestha ◽

Bhanumati Saikia Patowary

Keyword(s):

Liver Cirrhosis ◽

Peptic Ulcer ◽

Portal Hypertension ◽

Oesophageal Varices ◽

Gastrointestinal Bleed ◽

Variceal Bleed ◽

Upper Gastrointestinal Bleed ◽

Cirrhotic Patients ◽

Cirrhosis Of Liver ◽

Upper Gastrointestinal

Background & Objectives:Acute upper gastrointestinal (UGI) bleeding is a serious medical problem in patients with cirrhosis of liver associated with high mortality. Gastro-oesophageal variceal bleed is the most common complication of portal hypertension in patient with liver cirrhosis. This study was undertaken to establish the causes of UGI bleed in cirrhosis, their relative incidences, clinical presentation , endoscopic findings, outcomes during hospitalization including rebleeding and mortality were studied.Materials & Methods:One hundred and twenty patients with clinical features, sonological and endoscopic evidence of portal hypertension and cirrhosis of liver who presented with upper gastrointestinal bleed were included in the study. After haemodynamic stability, each patient underwent UGI endoscopy usually within 12 hours and the aetiology with diagnostic findings were documented. Results:Ruptured oesophageal varices was the most common cause of UGI bleed in cirrhotic patients. Non variceal causes of UGI bleed accounted for 33.3 % of cases. The majority of non variceal bleed was peptic ulcer disease and accounted for 19.2 % of total UGI bleed in liver cirrhosis. This was followed by portal hypertension gastropathy, erosive gastropathy, mallory-weiss tear and others.Conclusion:The most frequent causes of acute gastrointestinal bleeding in cirrhosis was oesophageal varices. Peptic ulcer disesase is also a common aetiology of UGI bleed in cirrhosis. Cirrhotic patients with variceal etiology have more chances of rebleeding and have higher mortality than those with non variceal aetiologies.

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A Randomized Controlled Study of Fuzheng Huayu Capsule for Prevention of Esophageal Variceal Bleeding in Patients with Liver Cirrhosis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/534960 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Jie Gu ◽

Qin Zhang ◽

Dongying Xue ◽

Hong Cai ◽

Lieming Xu

Keyword(s):

Variceal Bleeding ◽

Controlled Trial ◽

Survival Rates ◽

Controlled Study ◽

Esophageal Variceal ◽

Esophageal Variceal Bleeding ◽

Randomized Controlled ◽

Cirrhotic Patients ◽

Upper Gastrointestinal

To elucidate the role of Fuzheng Huayu Capsule, a herbal formula, in the prevention of esophageal variceal bleeding in cirrhotic patients, a multicenter randomized and placebo-controlled trial was carried out. One hundred forty-six cirrhotic patients with esophageal varices were enrolled to compare the probability of upper gastrointestinal bleeding and survival between Fuzheng Huayu Capsule group and controlled group for the duration of 2 years. The results demonstrated that the FZHYC could effectively reduce the risk of variceal bleeding and improve survival rates for cirrhotic patients with varices, especially the combination of the capsule and Propranolol, which presented a better effect; FZHYC could reduce the varices size in patients with small ones. Its effect may be related to the amelioration of hepatic fibrosis.

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Efficacy of Octreotide Versus Terlipressin along with Endoscopic Variceal Ligation (EVL) in Preventing Re-bleeding and Mortality in Acute Bleeding Esophageal Varices in Cirrhosis: A Randomized Prospective Study

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i32b31748 ◽

2021 ◽

pp. 95-102

Author(s):

Sunayana Lomte ◽

Sourya Acharya ◽

Vijendra Kirnake

Keyword(s):

Prospective Study ◽

Esophageal Varices ◽

Variceal Bleeding ◽

Primary Outcome ◽

Secondary Outcome ◽

Esophageal Variceal ◽

Esophageal Variceal Bleeding ◽

Bleeding Esophageal Varices ◽

Variceal Bleed ◽

Significant Difference

Background: Octreotide and terlipressin are two pharmacologic drugs used as an adjuvant therapy in the treatment of acute esophageal variceal bleeding. Large enough clinical trial data is not available, in comparing the efficacy of octreotide versus terlipressin as an adjunct to EVL for control of variceal bleed. Still, there is a scarcity of data on which is the better efficient drug amongst terlipress in and octreotide to control 5 days rebleeding. Aim: To compare efficacy of octreotide versus terlipressin in preventing the 6 weeks mortality (primary outcome) and 5 days rebleeding (secondary outcome) in cases of acute esophageal variceal bleeding. Method: All the patients of cirrhosis of liver presenting with upper gastrointestinal bleeding admitted in the Medicine Intensive Care Unit(MICU) at Acharya Vinoba Bhave Rural Hospital (AVBRH) will be enrolled. In this Randomized Prospective study ,patients presenting with acute esophageal variceal bleed, after diagnostic endoscopy during a period of one year (august 2020 to july 2021) will be randomised into two group by simple randomisation with chits: Group A will receive Terlipressin while Group B will receive Octreotide for 5 days combined with esophageal variceal ligation. These two groups will be compared in terms of hemodynamic effects, child pugh score, MELD (Model for End stage Liver Disease) score to predict 6 weeks mortality as primary outcome and 5 day treatment failure as secondary outcome according to Bavino VI consensus statement. Expected results: From our study we are anticipating that both octreotide and terlipressin will be equally efficacious in controlling the EVB when given along with EVL therapy and also there will be no difference in both the drugs in preventing 6 weeks mortality and 5 days rebleeding. Conclusion: There will be no significant difference between Terlipressin and Octreotide in preventing 6 week mortality and 5 day rebleeding in bleeding esophageal varices when given along with EVL therapy.

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Duodenal variceal bleed: an unusual cause of upper gastrointestinal bleed and a difficult diagnosis to make

BMJ Case Reports ◽

10.1136/bcr-2016-218669 ◽

2017 ◽

pp. bcr2016218669 ◽

Cited By ~ 2

Author(s):

Shradha Bhagani ◽

Conchubhair Winters ◽

Sulleman Moreea

Keyword(s):

Gastrointestinal Bleed ◽

Difficult Diagnosis ◽

Variceal Bleed ◽

Upper Gastrointestinal Bleed ◽

Upper Gastrointestinal

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Endoscopic ultrasound guided emergency coil and glue for actively bleeding duodenal varix after failed endoscopy

Journal of Digestive Endoscopy ◽

10.4103/0976-5042.165726 ◽

2015 ◽

Vol 6 (03) ◽

pp. 139-141

Author(s):

Narendra S. Choudhary ◽

Rahul Rai ◽

Puri Rajesh ◽

Sud Randhir

Keyword(s):

Endoscopic Ultrasound ◽

Anatomical Location ◽

Ultrasound Guided ◽

Gastrointestinal Bleed ◽

Duodenal Varix ◽

Variceal Bleed ◽

Upper Gastrointestinal Bleed ◽

Upper Gastrointestinal

AbstractManagement of ectopic variceal bleed may be difficult at times due to anatomical location or presence of collaterals. We present a case of an elderly cirrhotic male with acute upper gastrointestinal bleed due to a large duodenal varix successfully managed by endoscopic ultrasound guided coil placement along with glue (N-butyl-2-cyanoacrylate) injection.

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Causes of Upper GI Bleed: Variceal or non-variceal.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.04.3920 ◽

2020 ◽

Vol 27 (04) ◽

pp. 820-824

Author(s):

Talha Munir ◽

Muhammad Naeem Safdar ◽

Salman Azhar ◽

Rizwan Rasool Khan ◽

Samara Siddique ◽

...

Keyword(s):

Variceal Bleeding ◽

Tertiary Care ◽

Care Hospital ◽

Gi Bleeding ◽

Esophageal Variceal ◽

Esophageal Variceal Bleeding ◽

Upper Gi Bleeding ◽

Upper Gi ◽

Variceal Bleed ◽

Gi Bleed

Objectives: To determine the frequency of esophageal variceal bleed in patients with upper GI bleed presenting in a tertiary care hospital. Study Design: Cross sectional survey. Setting: Department of Medicine, Mayo Hospital, Lahore and Madinah Teaching Hospital, Faisalabad. Period: 6 months from 01-06-2018 to 31-12-2018. Material & Methods: Two hundred patients with upper GI bleed were included in the study. All the patients had upper GI endoscopy to determine the esophageal variceal bleeding which was documented as frequency distribution table. Results: Esophageal variceal bleed was seen among 108 (54%) patients while it was not present among 92 (46%) patients. Conclusion: Esophageal variceal bleeding is frequently present among patients with upper GI bleeding and should be suspected in every patient with upper GI bleeding.

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