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Published on: June 18, 2020
Comparison of gastrointestinal bleeding in patients with and without liver cirrhosis
Sara Margret Daðadóttir1, Arnar Bragi Ingason2, Johann Pall Hreinsson3
1Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Insights
Gastrointestinal bleeding (GIB) in liver cirrhosis patients is often from varices or hemorrhoids, unlike non-cirrhotics. While GIB mortality is similar, overall mortality is higher in cirrhotic patients.
Area of Science:
- Gastroenterology
- Hepatology
- Internal Medicine
Background:
- Upper gastrointestinal bleeding (GIB) is well-documented in liver cirrhosis patients.
- However, studies focusing on lower GIB in this population are limited.
- This study aims to elucidate the characteristics of GIB in patients with and without liver cirrhosis.
Purpose of the Study:
- To compare the clinical characteristics, management, and outcomes of GIB in patients with and without liver cirrhosis.
- To determine the distinct features of GIB in cirrhotic versus non-cirrhotic individuals.
- To identify differences in GIB causes and rebleeding rates between the two groups.
Main Methods:
- A retrospective study included cirrhotic patients hospitalized for GIB from 2010-2021.
- A control group of non-cirrhotic patients was matched in a 1:4 ratio.
- Inclusion criteria were overt bleeding leading to hospitalization.
Main Results:
- Of 102 cirrhotic patients with GIB, 85% had upper GIB and 15% had lower GIB.
- Common causes in cirrhotics included acute variceal bleeding (42%) and hemorrhoids (40%), versus 1% and 6% in controls, respectively.
- Gastric and duodenal ulcers were less frequent causes in cirrhotics (13% vs. 31% and 9% vs. 29%).
- Rebleeding rates were higher in cirrhotics (14% vs. 3%).
- GIB-related mortality was low (1% vs. 0.8%), but 45-day overall mortality was significantly higher in cirrhotics (10% vs. 5%).
Conclusions:
- GIB in liver cirrhosis patients is frequently associated with acute variceal bleeding and hemorrhoids.
- Gastric and duodenal ulcers are less common causes of GIB in cirrhotics compared to non-cirrhotics.
- Despite similar GIB-specific mortality, overall mortality within 45 days is significantly elevated in cirrhotic patients.
Objectives:
Upper gastrointestinal bleeding (GIB) in patients has been well-characterized in liver cirrhosis but studies on lower GIB are limited. The clinical characteristics, management and outcomes in patients with and without liver cirrhosis was compared to determine the overall features of GIB in patients with liver cirrhosis compared with non-cirrhotics.
Methods:
A retrospective study on cirrhotics hospitalized for GIB 2010-2021, matched with control group of non-cirrhotics (1:4) for upper vs. lower GIB. Patients with overt bleeding leading to hospitalization were included.
Results:
Overall, 396 patients had cirrhosis, 267 (67%) men, median age 62, alcoholic etiology 177/396 (45%), median MELD 12 (range 6-32). Overall 102 cirrhotics had GIB, matched with 391 non-cirrhotics. Overall 87 (85%) cirrhotic patients had upper and 15% lower GIB. Compared to non-cirrhotics, the cause of GIB was more commonly acute variceal bleeding (AVB) (42% vs. 1%), hemorrhoids 40% vs. 6% (p = 0.002), less commonly gastric ulcer 13% vs. 31% (p < 0.001), duodenal ulcer 9% vs. 29% (p < 0.001), 5% of cirrhotics used NSAIDs vs. 26% of controls (p < 0.001). Rebleeding occurred in 14% of cirrhotics vs. 3% in controls (p < 0.001). Only one cirrhotic patient (1%) died from GIB vs. 0.8% of controls within 45 days. Overall mortality 45 days after hospitalization was 10% in cirrhotics vs. 5% in controls (p < 0.001).
Conclusions:
Bleeding from gastric and duodenal ulcers were less common in cirrhotics than in controls. Bleeding from hemorrhoids was more common in cirrhotics. Mortality due to GIB was low in both groups but overall mortality was significantly higher in cirrhotics.
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