Upper Gastrointestinal Bleeding in Patients with Portal Hypertension

Dave, Pradyuman B.; Romeu, José Carlos; Messer, Julio

doi:10.1097/00004836-198304000-00004

Cited by 22 publications

(8 citation statements)

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“…Gastric erosions accounted for the remaining 14%. These data are in keeping with those from two large studies on this subject (22,23). For hemorrhages that occurred during the trial, varices were the cause in about 94% of the patients in whom a did not respond to conservative treatment and were treated by sclerotherapy or surgery.…”

Section: Discussionsupporting

confidence: 90%

β-blockade prevents recurrent gastrointestinal bleeding in well-compensated patients with alcoholic cirrhosis: A multicenter randomized controlled trial

et al. 1989

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To assess the efficacy of beta-blockers in preventing rebleeding in selected cirrhotic patients and to compare the tolerance, safety and patient compliance of a selective and a nonselective beta-blocker, 94 patients were randomly assigned to propranolol (32 patients), atenolol (32 patients) or placebo (30 patients). Randomization was made at least 15 days after the bleeding episode. Propranolol was given orally at increasing doses until the resting pulse rate was reduced by approximately 25%. Atenolol was given at a fixed dose of 100 mg per day. Patients were followed up for a mean of 357 days. Rebleeding occurred in 14 patients in the placebo group, 10 in the atenolol group and eight in the propranolol group. The incidence of rebleeding was significantly lower in patients receiving propranolol than in those on placebo (propranolol vs. placebo: p = 0.01, logrank test). Atenolol was less effective than propranolol (atenolol vs. placebo: p = 0.065, logrank test). Bleeding-free survival was better for patients on active drugs than for those on placebo (propranolol vs. placebo = p = 0.01, atenolol vs. placebo: p = 0.05, logrank test). Retrospective analysis revealed that, whatever the type of treatment, abstinence from alcohol was crucial in preventing rebleeding. We conclude that beta-blocker treatment is effective in preventing rebleeding from esophageal varices in carefully selected alcoholic cirrhotic patients who survive at least 2 weeks after acute variceal hemorrhage and stop drinking.

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Section: Discussionsupporting

confidence: 90%

β-blockade prevents recurrent gastrointestinal bleeding in well-compensated patients with alcoholic cirrhosis: A multicenter randomized controlled trial

et al. 1989

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“…In the present study, we were able to confirm several previous observations concerning variceal bleeding in cirrhotic patients, although there were some differences in the etiology of cirrhosis between the study groups. We found that, as reported in Western studies, 14–17 variceal bleeding accounted for more than 80% of first upper gastrointestinal bleeds in patients with esophageal varices, and most of these occurred within the initial 2 years from entry. Also, we demonstrated that three well‐known risk factors for variceal bleeding; the size of varix, RC sign and heavy alcohol consumption, had independent correlations with first variceal hemorrhage.…”

Section: Discussionsupporting

confidence: 78%

Clinical significance of variceal hemorrhage in recent years in patients with liver cirrhosis and esophageal varices

Park

Um²,

Lee

et al. 2004

J of Gastro and Hepatol

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“…The endoscopic diagnosis is carried out by observing the right place of the bleeding or viewing varices that have a considerable size varying from moderate to big in those cases where there is no other lesion that could justify the bleeding [1,6]. Early upper gastrointestinal endoscopy (in the first 24 hours after the beginning of bleeding) has been recommended because it allows the application of the adequate therapeutic treatment [14].…”

Section: Discussionmentioning

confidence: 99%

“…Bleeding from gastroesophageal varices is still an im-portant cause of hospital internment all over the world and is also one of the most severe consequences of portal hypertension [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. This specific type of bleeding is an immediate threat to life.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors, Incidence and Management for Acute Variceal Bleeding in the Liver Transplantation Era

Silva¹,

Boin²,

Filho³

et al. 2011

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Background: Gastroesophageal varices are the most common and clinically important part of the portosys-temic collaterals due to their tendency to rupture and cause massive gastrointestinal bleeding. Objective The aim of this work was to evaluate retrospectively the incidence and the factors of prediction for the treatment of bleeding by gastroesophageal varices in the patients attended in the Emergency Room of the Hospital State University of Campinas (Brazil) from the last ten years. Methods: The method used here consisted of a descriptive and retrospective study carried out from the analyses of the medical records of 769 patients with upper gastrointestinal bleeding of which 220 were admitted because of upper gastrointestinal bleeding caused by gastroesophageal varices during this same period. Results: The results showed that the gastroe-sophageal varices appeared in 28.6% of the patients and they were the second most common cause of upper gastrointestinal bleeding. While evaluating factors such as age, sex and the common individual records, it was proved that this disease occurs mainly among people between the third and the fifth decade of life, with the great majority of cases occurring in the fourth decade (29.2%), of which 76.8% were male. There was an association of hematemesis and melena in the admission of 57.7% of the patients and even ascites was a common diagnosis in 48.2% of them. Most of these patients (40%) were classified as Child class B at admis-sion. The early endoscopic exam was used for 96.8% of them and showed the presence of F3 varices in 38.5%, CB varices in 25.1% and RCS varices in 12.6%. Most of these varices (41.5%) were situated in the distal third of the esophagus. The most used pharmacological treatment was based on octreotide in 45.9% of the patients. They received 0.05 mg of intravenous octreotide and a maintenance dose of 1 mg per day in 98.6% of the cases, with efficacy in 74.2% of the patients. The tamponade with Sengstaken-Blakemore tube was applied in 30.5% of the patients, but it was observed that 69.7% of them did not present any consider-able progress and this situation led to their death. The endoscopic treatment was performed in 41.8% of the patients with efficacy in 81.5% of them. The sclerotherapy was used for 60.9% of the studied cases with Ethamolin® being the most used for sclerosing. Emergency surgery was used in just 8.6% of the patients studied and it controlled the bleeding in 78.9% of the cases. Conclusion: We concluded that gastroesophag-eal bleeding was an important cause of upper gastrointestinal hemorrhage, even in the liver transplantation era. Factors of prediction for this bleeding were the endoscopic classification, the presence of ascites and the degree of liver failure, according to the Child-Pugh classification

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Upper Gastrointestinal Bleeding in Patients with Portal Hypertension

Cited by 22 publications

References 0 publications

β-blockade prevents recurrent gastrointestinal bleeding in well-compensated patients with alcoholic cirrhosis: A multicenter randomized controlled trial

β-blockade prevents recurrent gastrointestinal bleeding in well-compensated patients with alcoholic cirrhosis: A multicenter randomized controlled trial

Clinical significance of variceal hemorrhage in recent years in patients with liver cirrhosis and esophageal varices

Prognostic Factors, Incidence and Management for Acute Variceal Bleeding in the Liver Transplantation Era

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