Patterns of gastrointestinal hemorrhage in hemophilia

Peptic ulcer has been reported to be the cause of bleeding in 53%-85% of hemophiliacs with gastrointestinal hemorrhage (GIH). The management of GIH in hemophiliacs during the past decade has been affected by the availability of plasma concentrates, an increasing occurrence of chronic liver disease, and widespread use of endoscopic procedures. To determine the present patterns of GIH, we reviewed our experience at the Hemophilia Center of Western Pennsylvania during the last 10 yr. Twenty-five (10.3%) of 243 hemophiliacs experienced 41 episodes of GIH. The severity of hemophilia and a history of retroperitoneal hemorrhage were significant risk factors for GIH. Duodenal ulcer (22%), unknown site (22%), and gastritis (14%) were the three most common diagnoses. The use of fiberoptic endoscopy resulted in the recognition of diagnoses such as gastritis, esophagitis, Mallory--Weiss syndrome, and esophageal varices. Red cell transfusion requirements of hemophiliacs with GIH were no different than those of nonhemophiliacs with GIH (p greater than 0.05). The amount of factor VIII replacement used by hemophiliacs with GIH correlated with the severity of gastrointestinal bleeding (p less than 0.01), but not with the cause of gastrointestinal bleeding (p greater than 0.05). In conclusion, hemophiliacs develop GIH secondary to a variety of causes as do nonhemophiliacs. Fiberoptic endoscopy, after correction of factor VIII level to 0.40 U/ml, is a safe and valuable diagnostic procedure in hemophiliacs. The specific etiology of GIH in hemophiliacs should be aggressively sought and appropriate specific therapy provided.