ACUTE UPPER GASTROINTESTINAL BLEEDING IN PATIENTS WITH CIRRHOSIS: ENDOSCOPIC FINDINGS
Article Sidebar
Main Article Content
Abstract
Objective: To determine the endoscopic findings in liver cirrhosis patients presenting with upper gastrointestinal bleeding.
Methodology: A descriptive observational study of 152 patients, of either gender, having liver cirrhosis presenting with acute upper gastrointestinal bleeding was conducted in the Department of Medicine, Lady Reading Hospital Peshawar, from July 2020 to December 2020. Demographic details were noted and relevant investigations were carried out. After resuscitation and stabilization, all patients were subjected to upper gastrointestinal endoscopy by a consultant gastroenterologist to detect endoscopic lesions causing upper gastrointestinal bleeding (UGIB). SPSS version 21 was used for data entry and analysis; post-stratification chi-square (x2) with p<0.05 was considered statistically significant.
Results: The mean age of 152 patients was 50.95±16.44 years, including 96 (63.2%) males and 56 (36.8%) females. Oesophageal varices were found in 133 (87.5%) patients, gastric varices in 41 (27%) and portal gastropathy in 57 (37.5%) patients. Non-variceal lesions included peptic ulcer disease in 21 (13.8%) patients and gastritis in 19 (12.5%) patients. Only 5 (3.3%) patients had normal endoscopic study. Oesophageal varices were more common in males (72% versus 28%; p=0.001) whereas, gastric varices were more common in female patients (56% versus 44%), which was statistically significant (p=0.003).
Conclusion: Portal hypertension related lesions were the most common underlying etiology in the study patients of liver cirrhosis, presenting with UGIB. The findings on endoscopy included oesophageal varices (87.5%), portal gastropathy (37.5%) and gastric varices (27%). Non-variceal lesions were peptic ulcer disease (13.8%) and gastritis (12.5%). Male gender had significant association with esophageal varices and female gender with gastric varices.
Article Details
Work published in JPMI is licensed under a
Creative Commons Attribution-NonCommercial 2.0 Generic License.
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
References
van Leerdam M E. Epidemiology of acute upper gastrointestinal bleed¬ing. Best Pract Res Clin Gastroenterol 2008;22(2):209-24. doi: 10.1016/j. bpg.2007.10.011.
González-González J A, García-Com¬pean D, Vázquez-Elizondo G, Gar¬za-Galindo A, Jáquez-Quintana JO, Maldonado-Garza H. Nonvariceal upper gastrointestinal bleeding in patients with liver cirrhosis. Clinical features, outcomes and predictors of in-hospital mortality. A prospective study. Annals hepatol 2011; 10 (3): 287-95.
Nelms DW, and. Pelaez CA. The Acute Upper Gastrointestinal Bleed. Surg Clin N Am 2018; 98: 047–1057. https://doi. org/10.1016/j.suc.2018.05.004 surgi¬cal.theclinics.com
Rockey DC, Elliott A, Lyles T. Predic¬tion of esophageal varices and variceal hemorrhage in patients with acute up¬per gastrointestinal bleeding. J Investig Med 2016;64:745–51.
McQuaid KR. Gastrointestinal Disorders. In: Papadakis MA, McPhee SJ, Rabow MW, (ed). Current Medical Diagnosis & Treatment 2020. 59th Ed. New York: McGraw-Hill; 2020:593- 690.
Ahmed J, Alam L, Shabbir K, Naqvi M, Haider E, Farooque A. Endoscopic find¬ings in patients presenting with upper GI bleed in a tertiary care facility. Pak Armed Forces Med J 2020; 70 (1): 112-17.
Mahajan P and Chandail VS. Etiological and endoscopic profile of middle aged and elderly patients with upper gas¬trointestinal bleeding in a Tertiary Care Hospital in North India: A retrospective analysis. J Mid-life Health 2017;8:137- 41.
Hadayat R, Jehangiri AR, Gul R, Khan AN, Said K, Gandapur A. Endoscopic findings of upper gastrointestinal bleed¬ing in patients with liver cirrhosis. J Ayub Med Coll 2015;27(2):391-94.
Jamil Z, Ahsan O, Ain QU, Malik M. Bio¬chemical and endoscopic evaluation of upper-gastrointestinal bleed in patients with liver cirrhosis. Pak Armed Forces Med J 2019; 69 (5): 1103-10.
Ahmed A, Ali L, Shehbaz L, Nasir S, Rizvi SRH, Aman MZ, et al. The prevalence of acute upper gastrointestinal bleeding and the factors causing hemorrhage as observed at a tertiary health care centre in Karachi, Pakistan. Pak J Surg 2017; 33(1):36-40.
Shah GM, Jamali AA, Khokhar RA, Rind S, Endoscopic Diagnosis in Patients with Acute Upper Gastrointestinal Bleeding. JIMDC 2017; 6(2):83-86.
Khan A, Ali M, Khan IM, Khan AG. Causes of severe upper gastrointestinal bleed¬ing on the basis of endoscopic findings. J Postgrad Med Inst 2006;20(2):154-8.
Hina R, Mansoor H, Bilal K, Asghar A, Ullah MAS, Zahid TR. Variceal Hemor¬rhage as the Commonest Cause of Pre¬sentation with Acute Upper Gastrointes¬tinal Bleeding: A Paradigm Shift. Ann Punjab Med Coll. 2021;15(3):195-98. DOI: 10.29054/APMC/2021.1168.
Afridi MA. Tobacco use as contributory factor in peptic ulcer disease. J Coll Phy¬sicians Surg Pak 2003 Jul;13(7):385- 87.
Afzal M, Tarar SH, Shah SMA. Spec¬trum of Endoscopic Findings in Patients with Liver Cirrhosis due to Chronic Viral Hepatitis. Pak J Med Health Sc2018. 12,(1);10-13.
Mohammad S, Chandio B, Shaikh A,. Soomro AA, Rizwan A. Endoscopic Findings in Patients Presenting with Upper Gastrointestinal Bleeding. Cureus 2019.11(3): e4280. DOI 10.7759/cu¬reus.4280.
HussainT, Sarfraz M, Rehman H, Batool U and Irfan K. Prevalence of peptic ulcer in patients of liver cirrhosis presenting with upper GI Bleed. J Rawalpindi Med Coll 2019; 23(3):169-72
Kausar S , Burney S, Jahanzeb Z, Fa¬rooq M, Zulfiqar A , Awab Q. Endoscopic Findings in Patients with Upper Gastro¬intestinal Bleeding at Pakistan Railway General Hospital, Rawalpindi. A Retro¬spective Review of 100 Cases. JIIMC 2018;13(3):146-50.
Malghani W, Malik R, Chaudhary F, Din ATU, Shahid M, Ahmad S et al. Spec¬trum of Endoscopic Findings in Pa¬tients of Upper Gastrointestinal Bleed¬ing at a Tertiary Care Hospital. Cureus 2019:11(4): e4562. DOI 10.7759/cu¬reus.4562.
Svoboda P, Konecny M, Martinek A, Hrabovsky V, Prochazka V, Ehrmann J .Acute upper gastrointestinal bleeding in liver cirrhosis patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2012; 156(3):266–70.
D’Amico G, De Franchis R and a Coop¬erative Study Group. Upper Digestive Bleeding in Cirrhosis. Post-therapeutic Outcome and Prognostic Indicators. Hepatology 2003;38:599-612.
Gabr MA, Tawfik MAER, El-Sawy AAA. Non-variceal upper gastrointestinal bleeding in cirrhotic patients in Nile Del¬ta. Ind J Gastroenterol 2016; 35(1):25- 32. doi: 10.1007/s12664-016-0622- 7. Epub 2016 Feb 17.
El-Badry M, Eltaweel N, Moussa AM. En¬doscopic Findings in Patients with Up¬per Gastrointestinal Bleeding in Upper Egypt: A Single Centre Study. Afro-Egypt J Infect Endem Dis 2020;10(2):183-91. https://aeji.journals.ekb.eg.
Surendran M, Kumar KS. Clinical and Endoscopic Profile of Upper Gastroin¬testinal Bleed: A Cross-sectional Study from a Tertiary Care Hospital in South¬ern India. J Clin Diag Res 2021; 15(3): 14-17.
Purbey BK, Gurung RB, Panday R, Acharya B, Mehta RK. The Etiology of Upper Gastrointestinal Bleeding in Patients with Liver Cirrhosis in Dhu¬likhel Hospital. Kathmandu Univ Med J.2017;60(4):292-5.
Alema ON, Martin DO, Okello TR. Endo¬scopic findings in upper gastrointesti¬nal bleeding patients at Lacor hospital, northern Uganda. Afri Health Sci 2012; (4): 518-21. http://dx.doi.org/10.4314/ ahs.v12i4.19.
Shyamsundar CM, Sharma GD, Rana BS. Profile of acute upper gastro in¬testinal bleed: a referral hospital-based study in sub Himalayan region. Int J Adv Med 2018;5(4):849-53. http:// www.ijmedicine.com. DOI: http:// dx.doi.org/10.18203/2349-3933. ijam20182994
Sharifian A, Tavakoli E, Ashtari S, Zali MR. Endoscopic Findings in Patients with Upper Gastrointestinal Bleeding Referred to Taleghani Hospital, Tehran, Iran. Govaresh 2017; 21:260-65.
Alatawi A, Aljohani W S, Aljayani R T, Al¬blowi Y, Yousuf M, Almutairi HII. Findings of Esophagogastroduodenoscopy in Patients Suspected of Upper Gastroin¬testinal Bleeding Referred to the Main Endoscopy Unit at King Fahad Spe¬cialist Hospital. Cureus 2020: 12(12): e11862. doi:10.7759/cureus.11862.
Jemilohun A C, Akande K O, Ngubor T D et al. Endoscopic Findings in Patients With Upper Gastrointestinal Bleeding in Ogun State, Nigeria. Cureus.2022 14(3): e23637. DOI10.7759/cu-reus.23637.