Spectrum of upper gastrointestinal bleed in patients with cirrhosis of liver

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. 

scholarly journals Peptic Ulcer Diseases in Patients with Liver Cirrhosis and Portal Hypertension: Experience in a Tertiary Level Hospital in Bangladesh

2021 ◽  
Vol 16 (2) ◽  
pp. 68-71
Author(s):  
Ahmed Lutful Moben ◽  
Md Abdullahel Kafee ◽  
Md Jahangir Kabir ◽  
Arunanagshu Raha ◽  
Farjana Majid ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Peptic Ulcer ◽  
Portal Hypertension ◽  
Peptic Ulcer Disease ◽  
Oesophageal Varices ◽  
Portal Hypertensive Gastropathy ◽  
Class Iii ◽  
Cross Sectional ◽  
Ulcer Disease ◽  
Cirrhosis Of Liver

Introduction: Cirrhosis of liver and peptic ulcer disease (PUD) are very common in Bangladesh. PUD may coexist with cirrhosis and portal hypertension. Haematemesis and melaena in cirrhosis of liver are not always from ruptured oesophageal varices; rather it may be due to bleeding peptic ulcer disease. Objective: To find the prevalence of PUD among patients with liver cirrhosis and portal hypertension. Materials and Methods: This cross sectional, descriptive study was conducted on 96 patients of cirrhosis of liver diagnosed with oesophageal varices at endoscopy unit of Kurmitola general hospital, during endoscopic evaluations in 4 months period from september 2017 to december 2017. Results: Total cirrhotic patients enrolled were 96 (M=61, F=35), mean age was 51.8 ± 14.2 yrs (18-86years). Hepatitis B virus (HBV) was the leading cause of cirrhosis in 54.1%, Hepatitis C virus (HCV) 5.2 %, proven non-alcoholic steatohepatitis (NASH) were 11.5% and rest were from unknown aetiology. Their average Child-Turcotte-Pugh (CTP) score were 8.6 (12-5), 37.6% associated with portal hypertensive gastropathy. Grade-III oesophageal varices found in 52 patients, whereas grade-II in 25 patients. Among this 96 patients 39 (40.6%) revealed peptic ulcer disease more in the form of gastric ulcer (n=23) than duodenal ulcer (n=10) and both (n=6). Most of the ulcers belonged to Forrest class III (76.9%). Conclusions: Variceal bleeding and portal hypertensive gastropathy are the common causes of bleeding and anaemia in patients with cirrhosis of liver. Peptic ulcer disease has been found to be one of the potential causes of haematemesis, melaena, and anaemia among these patients in Bangladesh. Large multicenter controlled studies are needed to confirm the reports. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 68-71

scholarly journals Noninvasive assessment of oesophageal varices presence and size in patients with liver cirrhosis using right liver lobe/serum albumin concentration

2007 ◽  
Vol 64 (7) ◽  
pp. 453-457
Author(s):  
Tamara Alempijevic ◽  
Vladislava Bulat ◽  
Nada Kovacevic ◽  
Rada Jesic ◽  
Srdjan Djuranovic ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Oesophageal Varices ◽  
Digestive Endoscopy ◽  
Liver Lobe ◽  
Albumin Ratio ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Upper Digestive Endoscopy ◽  
The Right

Background/Aim. Liver cirrhosis is a chronic, progressive disease and it is usually accompanied by portal hypertension. The development of oesophageal varices (OV) is one of the major complications of portal hypertension. Cirrhotic patients should be screened for the presence of OV when portal hypertension is diagnosed. In order to reduce the increasing burden that endoscopy units have to bear, some studies have attempted to identify parameters for noninvasive prediction of OV presence. The aim of our study was to evaluate the value of biochemical and ultrasonography parameters for prediction of OV presence. Methods. This study included 58 cirrhotic patients who underwent a complete biochemical workup, ultrasonography examination and upper digestive endoscopy. Right liver lobe diameter/albumin ratio was calculated and its correlation to the presence and degree of OV, and Child-Pugh score of liver cirrhosis explored. Results. The mean age of the patients included in the study was 53.07?13.09 years; 40 were males and 18 females. In the Child-Pugh class A were 53.4% patients, class B 39.7%, whereas 6.9% were in the class C. In 24.1% of the patients no OV were identified by upper digestive endoscopy, 19% had OV grade I, 34.5% grade II, 20.7% grade III, and 1.7% OV grade IV. The mean value of the right liver lobe diameter/ albumin ratio was 5.43?1.79 (range of 2.76?11.44). Statistically significant correlation (p < 0.01) was confirm by Spearman's test between OV grade and calculated index (? = 0.441). Conclusion. The right liver lobe diameter/albumin ratio is a noninvasive parameter which provides an accurate information pertinent to the determination of OV presence and their grading in patients with liver cirrhosis. .

scholarly journals Platelet Count/Splenic Diameter Ratio to Predict Oesophageal Varices in Portal Hypertension

2019 ◽  
Vol 2 (2) ◽  
pp. 192-196
Author(s):  
Buddhi Sagar Lamichhane ◽  
Manoj Koirala ◽  
Bishwo Raj Baral
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Portal Hypertension ◽  
Esophageal Varices ◽  
Rural Areas ◽  
Predictive Value ◽  
Tertiary Hospital ◽  
Diameter Ratio ◽  
Oesophageal Varices ◽  
Cirrhosis Of Liver

Background: One of the major causes of morbidity and mortality in Nepal is portal hypertension due to liver cirrhosis. In rural areas where a lot of cases of cirrhosis of liver are prevalent and endoscopic expertise and facilities are not available, predicting the presence of esophageal varices through non-invasive means may reduce a large number of unnecessary endoscopies. This study is to identify the relationship of platelet count /splenic bipolar diameter ratio with the presence of esophageal varices in portal hypertension. Materials and methods: Eighty patients were included in this study between Jestha 2072 to Baisakh 2073 with the diagnosis of portal hypertension admitted in Bir hospital, Kathmandu which is a tertiary hospital of government of Nepal, which were mostly due to liver cirrhosis. The patients fulfilling the inclusion criteria underwent lab investigations, ultra sonogram and UGI endoscopy. The data were assessed for descriptive studies and means were compared using t-test. The cut off value of platelet count to spleen diameter ratio of 1150 was used to predict the presence or absence of oesophageal varices. Statistical analysis was done using SPSS 20 software Results: Platelet count to splenic diameter ratio with a cut off value of 1150 has sensitivity of 89.7%, specificity of 83.3%, positive predictive value of 96.8% and negative predictive value of 58.8% (p= 0.002, CI=95%) with 89.5 % accuracy. Conclusion: Platelet count to splenic bipolar diameter ratio can be a good predictor of presence of esophageal varices in patients with portal hypertension in the resource poor settings.

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

2021 ◽  
Vol 12 (8) ◽  
pp. 76-80
Author(s):  
Shabir Ahmad Shiekh ◽  
Ali Imran ◽  
Showkat Ahmad Kadla ◽  
Mohammad Yasin ◽  
Bilal Ahmad Khan ◽  
...  
Keyword(s):  
Variceal Bleeding ◽  
Demographic Data ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Gastrointestinal Bleed ◽  
Northern India ◽  
Variceal Bleed ◽  
Upper Gastrointestinal Bleed ◽  
The World ◽  
Upper Gastrointestinal

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.

scholarly journals S1153 Antibiotic Prophylaxis for Upper Gastrointestinal Bleed in Liver Cirrhosis; Less May Be More

2021 ◽  
Vol 116 (1) ◽  
pp. S539-S540
Author(s):  
Adnan A. Khan ◽  
Yousaf B. Hadi ◽  
Syeda F. Naqvi ◽  
Raja Samir Khan ◽  
Rida Jannat ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Antibiotic Prophylaxis ◽  
Gastrointestinal Bleed ◽  
Upper Gastrointestinal Bleed ◽  
Upper Gastrointestinal

scholarly journals CLINICAL UTILITY OF RISK SCORES IN VARICEAL BLEEDING

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.

scholarly journals Gastrointestinal Bleeding Secondary to Portal Hypertensive Duodenopathy in a Patient with Decompensated Liver Cirrhosis

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Rohini Krishna ◽  
Samuel O. Igbinedion ◽  
Richie Diaz ◽  
Nazneen Hussain ◽  
Moheb Boktor
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Alcoholic Cirrhosis ◽  
The United States ◽  
Decompensated Liver Cirrhosis ◽  
Nonalcoholic Fatty Liver ◽  
Gastrointestinal Bleed ◽  
Hypertension Portal ◽  
Intrahepatic Portosystemic Shunt ◽  
Cirrhotic Patients

With alcoholic cirrhosis and nonalcoholic fatty liver disease continuously on the rise in the United States, there is also a corresponding rise in portal hypertension. Portal hypertensive duodenopathy (PHD) is a complication of portal hypertension not commonly seen in cirrhotic patients. We present a case of a 46-year-old man who presented with decompensated liver cirrhosis secondary to gastrointestinal bleed. The patient underwent esophagogastroduodenoscopy (EGD) with findings indicative of PHD. Patient subsequently underwent transjugular intrahepatic portosystemic shunt (TIPS) with resolution of gastrointestinal bleed. We highlight TIPS as a management strategy in patients with PHD for whom less invasive measures are not effective.

scholarly journals Study of clinical and endoscopic profile of dyspepsia and upper gastrointestinal bleed

2019 ◽  
Vol 6 (1) ◽  
pp. 106
Author(s):  
Akash Rajender ◽  
Priyanka Choudhary ◽  
Saumya Mathur ◽  
Rajat Bhargava ◽  
Shalini Upadhyay ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Malignant Lesion ◽  
Gi Endoscopy ◽  
Gastrointestinal Bleed ◽  
Upper Gi ◽  
Upper Gastrointestinal Bleed ◽  
Upper Gi Endoscopy ◽  
Gi Bleed ◽  
Gandhi Medical College ◽  
Upper Gastrointestinal

Background: Upper gastrointestinal bleed (UGIB) and dyspepsia are the commonest indications for an upper GI endoscopy (UGIE), which has the potential to provide both diagnostic and therapeutic intervention. Alarm symptoms in patients with dyspepsia need proper evaluation.Methods: In an observational hospital-based study, 5117 patient undergoing upper GI endoscopy were evaluated at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India. Detailed clinical and endoscopic profile was evaluated for subjects with dyspepsia and UGIB. Statistical analysis was done using SPSS version 21.0.Results: Dyspepsia (2887, 56.41%) followed by upper GI bleed (1124, 21.97%) were the most common indications for UGIE. In subjects presenting with UGIB, most patients had both hematemesis with Malena (48.04%), 48.93% were chronic alcoholics and nearly one fourth (26.96%) were on NSAIDS. Variceal bleeding (52.94%), followed by peptic ulcer bleed (13.43%) were the most common causes of bleed. In subjects undergoing UGIE for dyspepsia, 37.41% revealed no endoscopic lesion followed by gastro-duodenitis (25.01%). Peptic ulcer was cause of dyspepsia in 18.05% and was significantly more in those with alarm symptoms (<0.001). Alarm symptoms in dyspepsia has a significant high likelihood of finding a malignant lesion on endoscopic evaluation (p 0.013).Conclusions: Variceal bleed is the most common cause of UGIB in the adult Indian population. In patients with dyspepsia, presence of alarm symptoms is significantly associated with organic lesion on endoscopy. Although the incidence of malignancy is low, endoscopy in more than 50years subjects presenting with dyspepsia may help in early diagnosis and reducing morbidity.

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