The etiology of upper gastrointestinal bleeding in cirrhotic patients

AIMS To investigate the etiology of upper digestive hemorrhage in cirrhotic patients. PATIENTS AND METHODS From November 2004 to December 2006, we performed a prospective study at the Regional Institute of Gastroenterology and Hepatology "O. Fodor" Cluj-Napoca. The study was performed on 1,284 patients with esophageal varices from the endoscopy records, diagnosed with liver cirrhosis based on clinical, biochemical and endoscopic information, documented from the observation sheet. During the periodical examinations, we observed and monitored the patients' variceal and non-variceal bleedings. RESULTS Out of the 1,284 patients included in this study, there were 297 cases of upper digestive hemorrhage, the dominant etiology being the variceal bleeding (217 cases - 73%), and 80 (27%) cases of upper non-variceal digestive hemorrhage. Duodenal ulcer was the main cause for upper non-variceal digestive hemorrhage in case of cirrhotic patients considered for this study (33.75%), followed by gastric ulcer (21.25%), portal hypertensive gastropathy (17.5%), acute erosive gastritis (11.25%), Mallory-Weiss syndrome (6.25%), esophageal ulcer (5%), antral vascular ectasia (1.25%), duodenal polyps (1.25%) and exulcerated gastric tumor (1.25%). We also observed the cases of hemorrhagic relapse in the group of patients with variceal hemorrhages. Variceal bleedings are predominant in each Child-Pugh clinical category, but one must mention that the risk of variceal rupture increases with the severity of the hepatic disease. There were 8 deaths, all caused by esophageal variceal hemorrhages. CONCLUSIONS In our study, almost 27% of cirrhotic patients with upper gastrointestinal hemorrhage had bleeding from a non-variceal source, the most common etiology being peptic ulcer. Variceal bleeding is more severe and bears a higher mortality rate than non-variceal bleeding.