The etiology of upper gastrointestinal bleeding in patients with liver cirrhosis


Authors: P. Svoboda 1;  J. Ehrmann 2;  P. Klvaňa 1;  E. Machytka 1;  M. Rydlo 1;  V. Hrabovský 1
Authors‘ workplace: Interní klinika FN Ostrava, přednosta doc. MUDr. Arnošt Martínek, CSc. 1;  II. interní klinika Lékařské fakulty UP a FN Olomouc, přednosta doc. MUDr. Vlastimil Procházka, Ph. D. 2
Published in: Vnitř Lék 2007; 53(12): 1274-1277
Category: Original Contributions

Overview

108 patients suffering from the cirrhosis of the liver and acute bleeding into the upper digestive tract underwent a prospective endoscopic examination with diagnostic and therapeutic objectives. The most frequent causes of acute bleeding included oesophagus varices (57.4 %) followed by peptic gastric ulcer (13.9 %) and peptic ulcer of duodenum (11.1 %), then portal hypertension gastropathy (5.6 %), gastric varices (4.6 %), reflux oesophagitis (2.8 %), Mallory-Weiss syndrom (2.8 %) and erosive gastropathy (0.9 %). The endoscopy of the upper digestive tract in one patient resulted in negative diagnosis. 69 % of examinations showed multiple findings in the upper digestive tract, each of which could have been a potential cause of bleeding. To determine the source of bleeding the specialist´s attitude presented at the end of the endoscopic examination was taken into consideration. In 67.6 % of patients the bleeding was a direct consequence of portal hypertension, in 62 % it was caused by varices. The emphasis is put on early and thorough endoscopic examinations aimed at proper diagnosis and therapy.

Key words:
cirrhosis of the liver - portal hypertension - acute bleeding - peptic ulcer -endoscopy


Sources

1. Sherlocková S, Dooley J. Nemoci jater a žlučových cest. Hradec Králové: Olga Čermáková 2004.

2. Vaňásek T, Lata J. Krvácení z gastrointestinálního traktu při portální hypertenzi. In: Lata J, Vaňásek T et al. Kritické stavy v hepatologii. Praha: Grada Publishing 2005: 76.

3. Husová L, Lata J, Šenkyřík M et al. Akutní krvácení z horní části trávicí trubice - naše zkušěnosti. Vnitř Lék 2001; 47: 354-360.

4. Zavoral M, Mařatka Z. Krvácení do trávicího traktu. In: Mařatka Z. Gastroenterologie. Praha: Karolinum 1999: 435-445.

5. Lata J. Důsledky portální hypertenze a jejich léčba. In: Lata J et al. Portální hypertenze při jaterní cirhóze a její důsledky. Plzeň: GAAN CZ 2000; 41-55.

6. Brodanová M. Hepatologie. In: Klener P et al. Vnitřní lékařství. Praha: Galén 1999: 521-562.

7. Kantorová I, Svoboda J, Ochmann J et al. Duplicita zdroje krvácení u pacientů s jícnovými varixy. Rozhl Chir 1997; 76: 543-547.

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

9. Gostout ChJ, Viggiano TR, Balm RK. Acute gastrointestinal bleeding from portal hypertensive gastropathy: prevalence and clinical features. The American journal of gastroenterology 1993; 88: 2030-2033.

10. Rabinovitz M, Yoo YK, Schade RR et al. Prevalence of endoscopic findings in 510 consecutive individuals with cirrhosis evaluated prospectively. Dig Dis Sci 1990; 35: 705-710.

11. Tsai ChJ. Helicobacter pylori infection and peptic ulcer disease in cirrhosis. Dig Dis Sci 1998; 43: 1219-1225.

12. Auroux J, Lamarque D, Roudot-Thoraval F et al. Gastroduodenal ulcer and erosions are related to portal hypertensive gastropathy and recent alcohol intake in cirrhotic patients. Dig Dis Sci 2003; 48: 1118-1123.

13. Zaman A, Hapke R, Flora K et al. Prevalence of upper and lower gastrointestinal tract findings in liver transplant candidates undergoing screening endoscopic evaluation. Am J Gastroenterol 1999; 94: 895-899.

14. Svoboda P, Ehrmann J, Klvaňa P et al. Endoskopické nálezy v horním trávicím traktu u pacientů s jaterní cirhózou, Vnitř Lék 2007; 53: XXX-XXX.

15. Siringo S, Burroughs AK, Bolondi K et al. Peptic ulcer and its course in cirrhosis: an endoscopic and clinical prospective study. J Hepatol 1995; 22: 633-641.

16. Hashizume M, Tanaka K, Inokuchi K. Morphology of gastric microcirculation in cirrhosis. Hepatology 1983; 3: 1008-1012.

17. Sarfeh IJ, Soliman H, Waxman K et al. Impaired oxygenation of gastric mucosa in portal hypertension. The basis for increased susceptibility to injury. Dig Dis Sci 1989; 34: 225.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 12

2007 Issue 12

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account