Article

[Risk and causes of gastroesophageal bleeding in patients with liver cirrhosis].

Klinicki centar, Klinika za gastroenterologiju i hepatologiju, Nis, Srbiya.
Vojnosanitetski pregled. Military-medical and pharmaceutical review (impact factor: 0.18). 09/2007; 64(9):585-9. pp.585-9
Source: PubMed

ABSTRACT Variceal bleeding is the most life-threating complication in liver cirrhosis. The aim of this study was to analyze the sources of gastroesophageal bleeding in patients with liver cirrhosis and to ascertain the risk factors of bleeding from esophageal varices.
This prospective study included 52 patients with liver cirrhosis and portal hypertension. Severity of liver dysfunction according to Child's classification, coagulation parameters, and endoscopic findings were analyzed. In patients with varices we analyzed the size, color, location of varices, and the presence of red signs. The varices were classified as small, medium and large.
Esophageal varices were found in 76.9% of the patients. Isolated varices were present in 36.6%, and associated with other findings in 40.3%. Small varices were present in 10%, medium in 25% and large in 65% patients. Of them 55% had variceal bleeding. Variceal bleeding was present in 50% of the patients with medium and in 65.38% of the patients with large varices. There was no bleeding in the patients with small varices. Endoscopy revealed red signs before bleeding in 85% of the patients with large varices. There was a higher incidence of variceal bleeding in the Child's group B. There were no significant differences (p > 0.05) in the coagulation parameters in patients with and without variceal bleeding. Rebleeding was present in 86.36% of the patients. Most of them (52.63%) were rebleeding between 7 weeks and 12 months after the first episode of variceal bleeding. In the patients with the most severe hepatocellular dysfunction (Child's group C) the period between the first bleeding and rebleeding was the shortest (mean, 20.8 days).
Our study revealed that esophageal varices are the most frequent sources of bleeding in the patients with liver cirrhosis. There is the association between the first bleeding and large varices and the red signs. Coagulation disorders and hepatic dysfunction were not related to the initial episode of variceal bleeding. The risk of early rebleeding was higher in the patients with severe hepatic dysfunction (Child's class C).

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Keywords

52 patients
 
7 weeks
 
Child's class C
 
Child's classification
 
Child's group B
 
Child's group C
 
esophageal varices
 
first episode
 
hepatic dysfunction
 
higher incidence
 
initial episode
 
large varices
 
liver cirrhosis
 
liver dysfunction
 
prospective study
 
red signs
 
risk factors
 
severe hepatic dysfunction
 
severe hepatocellular dysfunction
 
small varices