Measurement of Exhaled Nitric Oxide in Cirrhotic Patients with Esophageal and Gastric Varices

Background and aims. This study aimed to detect exhaled nitric oxide (eNO) level in cirrhotic patients and explore the correlation between eNO levels and the severity of cirrhosis. Methods. Patients were enrolled to analyze the relationship of eNO with noncirrhosis, cirrhosis, and complications of decompensated cirrhosis. We explored the potential predictive values of eNO in different states of cirrhosis. Results. The eNO levels were significantly increased in cirrhotic patients compared with noncirrhotic patients (14 (10–18) vs 8 (6–13) ppb, P<0.001). The eNO level was increased in those with ascites (15 (14–22) vs 13 (10–18) ppb, P=0.026), with portal vein thrombosis (19.5 (11.75–22) vs 13.5 (10–17) ppb, P=0.032), or with the mucosal red-color sign of esophageal and gastric varices (EGV) (16.5 (10–21.75) vs 13 (10–14.75) ppb, P=0.041). Among cirrhotic patients undergoing hepatic venous pressure gradient (HVPG) measurement, the eNO level was significantly increased in the high-HVPG group (HVPG >12 mm Hg) compared with the low-HVPG group (6 mm Hg ≤ HVPG ≤ 12 mm Hg) (15 (11.75–19.25) vs 10 (8–14) ppb, P=0.011). Conclusions. The eNO level was increased in cirrhotic patients, especially in those complicated with ascites, portal vein thrombosis, mucosal red-color sign of varices, and high HVPG.

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

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.