Search

Objectives The aim of this study was to monitor the risk factors that trigger variceal bleeding in cirrhotic patients, assess the severity of the bleeding and the efficacy of the endoscopic hemostasis techniques, as well as the recurrence of bleeding episodes and the mortality rate. Materials and Methods The current study was a prospective one, and it was conducted in the period November 2004 - December 2006 in the “O. Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca. It included 273 patients with upper gastrointestinal bleeding because of variceal rupture, assessed by emergency endoscopy. The patients included in the study met the clinical, biochemical, endoscopic and ultrasound criteria for liver cirrhosis. Its etiology and staging were documented from the patients’ observation charts. Results Out of the 273 cases of variceal bleeding there were 255 (93.4%) cases of bleeding from esophageal varices and 18 (6.6%) from gastric varices. Variceal bleeding episodes were more frequent in patients with alcoholic liver cirrhosis (51.28%). Most patients with variceal bleeding were in Child class B or C (77%). Mortality because of variceal hemorrhage was 2.93% in the study group. A number of 148 patients were treated by sclerotherapy and 125 patients with elastic ligatures. Bleeding relapses occurred in 65 (23.8%) patients within the study group, 43 men and 22 women. Variceal bleeding relapses were more frequent after sclerotherapy than after elastic ligatures. Conclusions Variceal bleeding occurred more frequently in patients with alcoholic cirrhosis stage Child C. In the current study mortality was relatively low. The treatment of bleeding recurrence is more difficult, hence variceal rupture prevention and application of elastic ligatures represent a therapeutic necessity.

Aims To investigate the etiology of upper digestive hemorrhage in cirrhotic patients. Patients and methods From November 2004 to December 2006, we performed a prospective study at the Regional Institute of Gastroenterology and Hepatology “O. Fodor” Cluj-Napoca. The study was performed on 1,284 patients with esophageal varices from the endoscopy records, diagnosed with liver cirrhosis based on clinical, biochemical and endoscopic information, documented from the observation sheet. During the periodical examinations, we observed and monitored the patients’ variceal and non-variceal bleedings. Results Out of the 1,284 patients included in this study, there were 297 cases of upper digestive hemorrhage, the dominant etiology being the variceal bleeding (217 cases - 73%), and 80 (27%) cases of upper non-variceal digestive hemorrhage. Duodenal ulcer was the main cause for upper non-variceal digestive hemorrhage in case of cirrhotic patients considered for this study (33.75%), followed by gastric ulcer (21.25%), portal hypertensive gastropathy (17.5%), acute erosive gastritis (11.25%), Mallory-Weiss syndrome (6.25%), esophageal ulcer (5%), antral vascular ectasia (1.25%), duodenal polyps (1.25%) and exulcerated gastric tumor (1.25%). We also observed the cases of hemorrhagic relapse in the group of patients with variceal hemorrhages. Variceal bleedings are predominant in each Child-Pugh clinical category, but one must mention that the risk of variceal rupture increases with the severity of the hepatic disease. There were 8 deaths, all caused by esophageal variceal hemorrhages. Conclusions In our study, almost 27% of cirrhotic patients with upper gastrointestinal hemorrhage had bleeding from a non-variceal source, the most common etiology being peptic ulcer. Variceal bleeding is more severe and bears a higher mortality rate than non-variceal bleeding.