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Acute upper gastrointestinal bleeding in cirrhosis: changes and advances over the past two decades

Jean Henrion1, Pierre Deltenre, Stéphane De Maeght

  • 1Unité d'Hépato-Gastroentérologie, Hôpital de Jolimont, Haine-Saint-Paul, Belgium. jeanhenrion@yahoo.fr

Acta Gastro-Enterologica Belgica
|November 23, 2011
PubMed

Insights

Outcomes for cirrhotic patients with upper gastrointestinal bleeding (UGIB) have significantly improved over two decades. Despite increased cirrhosis severity, advancements in endoscopic therapy reduced rebleeding, transfusions, and mortality.

Area of Science:

  • Gastroenterology
  • Hepatology
  • Internal Medicine

Background:

  • Upper gastrointestinal bleeding (UGIB) is a critical complication in cirrhotic patients.
  • Few studies have compared UGIB patient cohorts separated by decades.

Purpose of the Study:

  • To compare epidemiological, clinical, therapeutic, and prognostic features of UGIB in cirrhotic patients across two distinct 20-year periods.
  • To assess changes in patient characteristics and outcomes for cirrhotic patients with UGIB over time.

Main Methods:

  • Retrospective comparison of 100 cirrhotic patients with UGIB admitted between 1984-1990 (Cohort A) and 100 admitted between 2004-2009 (Cohort B).
  • Analysis included patient demographics, cirrhosis severity (Child-Pugh score), endoscopic interventions, blood transfusions, rebleeding rates, surgical interventions, and in-hospital mortality.

Main Results:

  • Patient demographics (sex ratio, age, alcoholic cirrhosis prevalence) remained consistent.
  • Cirrhosis severity increased significantly (Child-Pugh score mean 7.6 to 8.8; Child-Pugh C 19% to 35%).
  • Endoscopic therapeutic interventions rose (13% to 50%), while transfusions decreased (85 to 58 patients). Rebleeding (45% to 11%), rescue surgery (8% to 0%), and in-hospital mortality (24% to 9%) significantly reduced in the recent cohort.

Conclusions:

  • Despite increased cirrhosis severity, outcomes for cirrhotic patients with UGIB have markedly improved over two decades.
  • Enhanced endoscopic therapeutic strategies have contributed to better patient prognoses.
  • The study highlights significant advancements in managing UGIB in cirrhotic patients.
Abstract

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