Erosive Gastritis and Acute Gastroduodenal Ulcerations as Source of Upper Gastrointestinal Bleeding in Liver Cirrhosis

Abstract

This retrospective study was initiated to compare the frequency of acute gastric mucosal lesions (AGML) (including erosive gastritis and acute gastroduodenal ulcerations) in patients with and without liver cirrhosis. 466 upper gastrointestinal bleeders were reviewed, including 167 cirrhotic and 299 noncirrhotic patients. In all of them, emergency esophagoscopy and/or gastroscopy were performed, followed by immediate upper GI X-ray examination. The overall incidence of AGML in cirrhotic and in noncirrhotic upper GI bleeders was high but very similar (38.0 and 41.8%, respectively). This speaks against the significance of liver cirrhosis and portal hypertension as etiologic factors in AGML. Bleeding esophageal varices were the sole cause of upper GI bleeding in 51.5% of our cirrhotics. The frequency of chronic gastric or duodenal ulcer in liver cirrhosis as the cause of bleeding in our city hospital population was less than ¼ of that seen in noncirrhotic bleeders. Excessive alcoholic intake just preceding the bleeding was found in about 45% of cirrhotic and noncirrhotic patients with AGML and in about ²/₃ of the cirrhotics who bled from esophageal varices. The chronic alcoholism was equally frequent in cirrhotics who bled from AGML and those who bled from varices. About 40% of cirrhotics with variceal bleeding expired, but the mortality of cirrhotics bleeding from AGML was less than 10%. The importance of the early endoscopic diagnosis of the source of the upper GI bleeding in cirrhotics is self-evident for prognostic evaluation and therapeutic planning, both of which are different in bleeding from esophageal varices and from AGML.

Upper gastrointestinal bleeding in cirrhosis: clinical and endoscopic correlations.

“…The present study confirms what other authors have reported: that bleeding in patients with cirrhosis may be due to several causes other than varices (Palmer, 1969;Khodadoost and Glass, 1972;Bordas, et al, 1973;Rueff, 1974;Waldram et al, 1974;Hoare, 1975).…”

“…Endoscopy has shown that the rupture of gastro-oesophageal varices accounts for rather less than half the number ofepisodes of haemorrhage in cirrhotics. Other sources of bleeding are gastroduodenal ulcers or acute mucosal lesions, and many patients bleed from several lesions simultaneously (Palmer, 1969;Khodadoost and Glass, 1972;Waldram et al, 1974;Rueff, 1974;Hoare, 1975).…”

Aetiology of Upper Gastrointestinal Haemorrhagean Endoscopic Study

“…We found oesophagitis, gastritis and duodenal ulcer coexisting with oesophageal varices but active bleeding was from varices in all except three patients where it was due to gastritis or duodenal ulcer. In studies from the west, as many as 38-68% of patients are reported to bleed from lesions other than the co-existing varices [10,11]. Endoscopy was non contributory in 11.5% of our patients.…”

Portal Hypertensive Gastropathy

“…Severe gastropathy probably ac counts for most nonvaricca! bleeding episodes in patients with cirrhosis and PHTN [25][26][27][28]. Bleeding from PHG is a serious complication, which is more often chronic and insidious [7,15,16,23], but occasionally may be massive and life-threatening [1,[5][6][7][8]23], Acute bleed ing from PHG occurred in only 0.8%, of a total of 1,496 patients admitted with upper gastrointestinal hemorrhage [29], Opposite observations are reported by other investiga tors [1], In other series [30], overt gastrointes tinal bleeding occurred in 30% of patients with mild PHG and 60% of patients with severe PHG.…”