Comparison of clinical outcomes between variceal and non‐variceal gastrointestinal bleeding in patients with cirrhosis

Tandon, Parul; Bishay, Kirles; Fisher, Stacey; Yelle, Dominique; Carrigan, Ian; Wooller, Krista; Kelly, Erin

doi:10.1111/jgh.14147

Cited by 32 publications

(27 citation statements)

References 41 publications

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“…All these factors help to clarify our observation of longer hospital LOS in patients with AVB than those with NVB. This is consistent with other studies which have documented the shorter hospital LOS in cirrhotic patients if the source of upper GIT bleeding is not variceal [3,23].…”

Section: Resultssupporting

confidence: 92%

“…In this study, certain factors were associated with increased Hospital LOS in the AVB group and NVB group as well. In-hospital re-bleeding is the main risk factor noted in both groups which is in agreement with other studies which have shown that in-hospital re-bleeding within 72 hours of admission increase the risk of ICU admission, hospital LOS and overall mortality [3,4,11], Other factors include the presence of ascites, experiences of hepatic encephalopathy during admission, high MELD score and advanced Child score. On the other hand hospital LOS was not related to Age,…”

Section: Resultssupporting

confidence: 91%

“…Acute upper gastrointestinal bleeding (UGIB) is the most common gastroenterological emergency in patients with cirrhosis and correlated with significant morbidity and mortality [1,2]. Acute variceal bleeding (AVB) is the leading cause of UGIB in cirrhosis and account for up to 70% of all cases [3,4], while non variceal bleeding (NVB) is a considerable cause of UGIB and responsible for the remaining cases, with the most frequent being peptic ulcer disease (PUD) [5]. In recent years significant amelioration in the therapeutic management of UGIB and improvement of hemostatic therapies resulted in a reduction of mortality and improvement of prognosis whether the cause is variceal [6,7] or non-variceal [7,8] Observational studies have demonstrated the higher mortality rate among patients with a bleeding Peptic ulcer with cirrhosis than in those without liver disease [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Upper gastrointestinal bleeding in patients with liver cirrhosis, Is the difference of clinical outcomes depend on the source?

Mohamed

Elgohary

Bassiony

et al. 2020

Preprint

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Background and Study Aims Acute upper gastrointestinal bleeding (UGIB) is the most common gastroenterological emergency in patients with cirrhosis; It increases the hospital length of stay (LOS), and Chance of 30-day hospital readmission. It has not been clarified if there is a difference in the prognosis of UGIB in cirrhosis depending on the source of bleeding. We aimed to investigate clinical outcomes in patients with cirrhosis with either acute variceal bleeding (AVB) or non-variceal bleeding (NVB) and risk factors for prolonged hospital LOS in both groups.Patients and Methods From July 2016 to January 2017, all adult eligible patients hospitalized with cirrhosis and UGIB were enrolled in the retrospective study, we assessed clinical outcomes in both groups and factors associated with prolonged hospital LOS.Results Of the 608 patients included in the study, 416 had variceal and 192 non-variceal bleeding. Mortality was higher in AVB group compared to NVB (12.5% vs. 8.3%, P= 0.023). There was a trend towards increased the length of hospital stay for those who had an AVB compared to NVB (5.84±2.16 vs. 4.33±1.18, p=0.001). Rate of hospital Readmission was also higher in the AVB group. Risk factors for prolonged hospital LOS were in hospital rebleeding, presence of Hepatic encephalopathy or ascites, higher MELD score and Patients with child score B, C.Conclusion Patients with cirrhosis and AVB have higher mortality rate, longer hospital LOS and re-hospitalization rate than those with NVB.

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Section: Resultssupporting

confidence: 92%

Section: Resultssupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Upper gastrointestinal bleeding in patients with liver cirrhosis, Is the difference of clinical outcomes depend on the source?

Mohamed

Elgohary

Bassiony

et al. 2020

Preprint

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“…Differentiation between acute VH and other sources of upper GI bleeding in the cirrhotic patient is an important consideration, as this population experiences nontrivial rates of peptic ulcer disease. 32,33 As the interventional approach to arterial and variceal bleeding sources differs substantially, clear delineation of the hemorrhage source is compulsory (►Fig. 1).…”

Section: Diagnosis Of Variceal Hemorrhagementioning

confidence: 99%

Emergent Transjugular Intrahepatic Portosystemic Shunt Creation in Acute Variceal Bleeding

Pandhi

Kuei

Lipnik

et al. 2020

Semin intervent Radiol

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Emergent transjugular intrahepatic portosystemic shunt (TIPS) creation is most commonly employed in the setting of acute variceal hemorrhage. Given a propensity for decompensation, these patients often require a multidisciplinary, multimodal approach involving prompt diagnosis, pharmacologic therapy, and endoscopic intervention. While successful in the majority of cases, failure to medically control initial bleeding can prompt interventional radiology consultation for emergent portal decompression via TIPS creation. This article discusses TIPS creation in emergent, acute variceal hemorrhage, reviewing the natural history of gastroesophageal varices, presentation and diagnosis of acute variceal hemorrhage, pharmacologic therapy, endoscopic approaches, patient selection and risk stratification for TIPS, technical considerations for TIPS creation, adjunctive embolotherapy, and the role of salvage TIPS versus early TIPS in acute variceal hemorrhage.

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“…Acute upper gastrointestinal bleeding (AUGIB) is a lifethreatening and frequent complication in cirrhosis with its mortality approaching 5-20% [1][2][3][4]. About 70% of AUGIB episodes in cirrhosis are due to esophageal variceal rupture secondary to portal hypertension [5].…”

Section: Introductionmentioning

confidence: 99%

No Benefit of Hemostatic Drugs on Acute Upper Gastrointestinal Bleeding in Cirrhosis

Bai

et al. 2020

BioMed Research International

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Background and Aims. Acute upper gastrointestinal bleeding (AUGIB) is one of the most life-threatening emergency conditions. Hemostatic drugs are often prescribed to control AUGIB in clinical practice but have not been recommended by major guidelines and consensus. The aim of this study was to investigate the therapeutic effect of hemostatic drugs on AUGIB in cirrhosis. Methods. All cirrhotic patients with AUGIB who were admitted to our hospital from January 2010 to June 2014 were retrospectively included. Patients were divided into hemostatic drugs and no hemostatic drug groups. A 1 : 1 propensity score matching (PSM) analysis was performed by adjusting age, gender, etiology of liver disease, Child-Pugh score, MELD score, hematemesis, red blood cell transfusion, vasoactive drugs, antibiotics, proton pump inhibitors, and endoscopic variceal therapy. Primary outcomes included 5-day rebleeding and in-hospital mortality. Results. Overall, 982 cirrhotic patients with AUGIB were included (870 in hemostatic drugs group and 112 in no hemostatic drug group). In overall analyses, hemostatic drugs group had a significantly higher 5-day rebleeding rate (18.10% versus 5.40%, P=0.001) than no hemostatic drug group; in-hospital mortality was not significantly different between them (7.10% versus 4.50%, P=0.293). In PSM analyses, 172 patients were included (86 patients in each group). Hemostatic drugs group still had a significantly higher 5-day rebleeding rate (15.10% versus 5.80%, P=0.046); in-hospital mortality remained not significantly different (7.00% versus 3.50%, P=0.304) between them. Statistical results remained in PSM analyses according to the type of hemostatic drugs. Conclusions. The use of hemostatic drugs did not improve the in-hospital outcomes of cirrhotic patients with AUGIB.

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Comparison of clinical outcomes between variceal and non‐variceal gastrointestinal bleeding in patients with cirrhosis

Abstract: There were no differences in clinical outcomes, including mortality, in cirrhotic patients admitted with AVB and NVB.

Cited by 32 publications

References 41 publications

Upper gastrointestinal bleeding in patients with liver cirrhosis, Is the difference of clinical outcomes depend on the source?

Upper gastrointestinal bleeding in patients with liver cirrhosis, Is the difference of clinical outcomes depend on the source?

Emergent Transjugular Intrahepatic Portosystemic Shunt Creation in Acute Variceal Bleeding

No Benefit of Hemostatic Drugs on Acute Upper Gastrointestinal Bleeding in Cirrhosis

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