Gastrointestinal Bleeding with Cirrhosis

Merigan, Thomas C.; Hollister, Robert M.; Gryska, Paul F.; Starkey, George W.B.; Davidson, Charles S.

doi:10.1056/nejm196009222631203

Cited by 70 publications

(4 citation statements)

References 14 publications

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“…This comparative rarity of chronic gastric or duodenal ulcer as the cause of bleeding in cirrhotics is very striking indeed. It conflicts with the old tenet, formulated prior to the vigorous endoscopic study of upper gastrointestinal bleeding, that gastric or duodenal ulcer is a frequent source of the upper GI bleeding in cirrhotics [5,7,16,24].…”

Section: Discussionmentioning

confidence: 99%

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

Khodadoost

Glass²

1972

Digestion

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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.

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Section: Discussionmentioning

confidence: 99%

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

Khodadoost

Glass²

1972

Digestion

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“…Hemorrhagic gastritis of the 23 cases in the C-group was investigated in relation to the grade of esophageal varices and severity of cirrhosis. 1) Relationship with Risky Varices (Table 8) Table 8 presents the relationship between risky varices and hemorrhagic gastritis. Risky varices were found in 10 cases (43.5%), while they were not seen in 13 cases (56.5%).…”

Section: Analysis Of Hemorrhagic Gastritis In Relation To Liver Cirrhmentioning

confidence: 99%

Endoscopic and Clinical Study on Hemorrhagic Gastritis in Patients With Liver Cirrhosis

Iwao

Toyonaga

Tanaka

et al. 1990

Digestive Endoscopy

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During a 5‐year period from 1984 through 1988, an emergency endoscopy was performed for an upper digestive tract hemorrhage in 283 consecutive patients with 290 lesions. Of these, 54 patients were diagnosed as having hemorrhagic gastritis on the basis of the endoscopic findings and were employed as the subjects of the present study. They were classified on the basis of the presence/absence of liver cirrhosis into two groups, i. e. the cirrhosis group (C‐group) and non‐cirrhosis group (NC‐group), and the two groups were comparatively studied. The incidence of hemorrhagic gastritis in hemorrhagic sources of the upper digestive tract was higher in the C‐group than in the NC‐group, and it was seen in the gastric body most frequently. In addition, no clear causes for hemorrhagic gastritis could be identified in many of the cases in the C‐group. These clinical findings were thought to indicate that, in patients with liver cirrhosis, the gastric mucosa itself, especially of the gastric body, is in an impending state of mucosal hemorrhage. A hemorrhage was the major cause of death in the C‐group. In patients with liver cirrhosis, the incidence of hemorrhagic gastritis had no correlation with the grade of esophageal varices, but was high in patients with severe liver cirrhosis. Thus, patients with severe liver cirrhosis were considered to be a high risk group of hemorrhagic gastritis.

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“…A review of the literature shows an immediate mortality of 62.5 per cent in 1926 reported cases (Ratnoff and Patek, 1942;Higgins, 1947;Reynolds et al, 1952;Atik and Simeone, 1954;Hamilton, 1955;Nachlas et al, 1955;Linton and Ellis, 1956;Welch et al, 1956;Weber, 1957;Cohn and Blaisdell, 1958;Conn, 1958;Liebowitz, 1959;TaylorandJontz, 1959;Gowand McGregor, 1960;Merigan et al, 1960;Read et al, 1960;Edmunds and West, 1961;Orloff, 1962;Garceau and Chalmers, 1963;Hislop et al, 1966;Orloff, 1967;Rothwell-Jackson and Hunt, 1971). Most of these series refer to patients with alcoholic cirrhosis.…”

mentioning

confidence: 99%

Transabdominal suture of bleeding gastro-oesophageal varices in cryptogenic cirrhosis of the liver

Lam

Cheng

et al. 1977

British Journal of Surgery

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Emergency transabdominal suture of gastro-oesophageal varices was performed when conventional conservative measures including oesophageal tamponade failed to control bleeding in 60 of 167 patients with cryptogenic cirrhosis and bleeding varices. The immediate mortality for the whole series was 29-9 per cent. Surgery performed in this selected manner carried an immediate mortality of 40 per cent. The transabdominal approach detected and treated 19 (31-7 per cent) patients who had concomitant bleeding from extra-oesophageal sources. Ageing and sex (male) affect the immediate prognosis adversely. Using a modification of Child's classification of hepatic dysfunction, a direct relationship between hepatic dysfunction and mortality was found, reaching 100 per cent in those with grade C (severe) dysfunction, irrespective of whether or not surgery had been performed. Bleeding was successfully arrested in 96-7 per cent of cases and recurrence of bleeding was acceptably low in the first 6 months of surgery but not after.

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Gastrointestinal Bleeding with Cirrhosis

Cited by 70 publications

References 14 publications

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

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

Endoscopic and Clinical Study on Hemorrhagic Gastritis in Patients With Liver Cirrhosis

Transabdominal suture of bleeding gastro-oesophageal varices in cryptogenic cirrhosis of the liver

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