Gastric Variceal Bleeding In Patients of Liver Cirrhosis With Portal Hypertension

Muhammad Fahad Zakir; Adeel Afzal; Hamid Ali Kalwar; Ghulam Mujtaba; Shahid Karim; Manzoor Hussain

doi:10.51253/pafmj.v74i3.8524

Authors

Muhammad Fahad Zakir Liaquat National Hospital and Medical College, Karachi Pakistan
Adeel Afzal Patel Hospital Karachi Pakistan
Hamid Ali Kalwar Indus Hospital & Health Network Karachi Pakistan
Ghulam Mujtaba Lyari General Hospital Karachi Pakistan
Shahid Karim Liaquat National Hospital and Medical College, Karachi Pakistan
Manzoor Hussain Indus Hospital & Health Network Karachi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i3.8524

Keywords:

Chronic liver disease, Cirrhosis, Esophageal varices, Gastric variceal, Portal hypertension.

Abstract

Objective: to establish how common Gastric Variceal bleeding is in Chronic liver Disease patients to allow them to be screened regularly and avoid morbidity and mortality.

Study Design: Cross sectional study.

Place and Duration of Study: Gastroenterology Department, Liaquat National Hospital and Medical College, Karachi Pakistan, from Jan to Dec 2020.

Methodology: A total of 135 patients with history of melena, hematemesis and known diagnosis of Chronic liver Disease for more than six months who fulfilled the inclusion criteria were enrolled in this study. Gastroscopy was carried out and dilated veins in the gastric fundus, either with active spurter or an overlying punctum, were labelled as Gastric Variceal bleeding.

Results: This study included known Chronic Liver Disease patients for duration of 6 months or more with recent stigmata of upper Gastrointestinal Bleed. Out of 135 cases, 76(56.3%) were male and 59(43.7%) were female. Enrolled patients’ mean age was 51.0±5.2 years, and the mean duration of Chronic liver Disease was 4.9±2.6 years. Gastric Variceal bleeding in Chronic liver Disease patients who underwent endoscopy had a frequency of 18(13.3%) times.

Conclusion: Gastric Variceal bleeding bleeding is rare but lethal complication of Chronic liver Disease, seen in patients in the age group of <50 years, female gender, hypertensive patients, and those with a duration of chronic liver disease <5 years.

Downloads

Download data is not yet available.

References

Boregowda U, Umapathy C, Halim N, Desai M, Nanjappa A, Arekapudi S, et al. Update on the management of gastrointestinal varices. World J Gastrointest Pharmacol Ther 2019;10(1):1. https://doi.org/10.4292/wjgpt.v10.i1.1

Saad WE, Darcy MD. Transjugular Intrahepatic Portosystemic Shunt (TIPS) versus Balloon-occluded Retrograde Transvenous Obliteration (BRTO) for the Management of Gastric Varices. Semin Intervent Radiol 2011;28(3):339-349.

https://doi.org/10.1055/s-0031-1284461

Elwakil R, Montasser MF, Abdelhakam SM, Ibrahim WA. N-butyl-2-cyanoacrylate, iso-amyl-2-cyanoacrylate and hypertonic glucose with 72% chromated glycerin in gastric varices. World J Gastrointest Endosc 2015 ;7(4):411-416.

https://doi.org/10.4253/wjge.v7.i4.411

Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 1992;16(6):1343-1349. https://doi.org/10.1002/hep.1840160607

Young-Suk L. Practical approach to endoscopic management for bleeding gastric varices. Korean J Radiol 2012;13(1): S40-S44.

https://doi.org/10.3348/kjr.2012.13.S1.S40

Christodoulou D, Tsianos EV, Kortan P, Marcon N. Gastric and ectopic varices – newer endoscopic options. Ann Gastroenterol 2007;20(2):95-109.

Garcia‐Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017;65(1):310-335.

Wani ZA, Bhat RA, Bhadoria AS, Maiwall R, Choudhury A. Gastric varices: Classification, endoscopic and ultrasonographic management. J Res Med Sci 2015;20(12):1200-1207.

https://doi.org/10.4103/1735-1995.172990

Garcia-Tsao G, Sanyal AJ, Grace ND. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007;46(3):922-938. https://doi.org/10.1002/hep.21907

De-Franchis R, Primignani M. Natural history of portal hypertension in patients with cirrhosis. Clin Liver Dis 2001;5(3):645-663.

https://doi.org/10.1016/s1089-3261(05)70186-0

Gralnek IM, Jensen DM, Kovacs TO. The economic impact of esophageal variceal hemorrhage: Cost-effectiveness implications of endoscopic therapy. Hepatology 1999;29(1):44-50.

https://doi.org/10.1002/hep.510290141

Irani S, Kowdley K, Kozarek R. Gastric varices: an updated review of management. J Clin Gastroenterol 2011;45(2):133-148 https://doi.org/10.1097/MCG.0b013e3181fbe249

Laine L. Upper gastrointestinal tract cyanoacrylate injections versus band ligation hemorrhage. West J Med 1991;155(3):274-279.

Shaikh NA, Khatri GK, Bhatty SA, Irfan M. Endoscopic diagnoses in patients with upper gastrointestinal bleeding. Med Channel 2010; 16:30-34.

Hadayat R, Jehangiri AR, Gul R. Endoscopic findings of upper gastrointestinal bleeding in patients with liver cirrhosis. J Ayub Med Coll Abbottabad 2015;27(2):391-394.

Hameed K, Khan Y, Saeed A, Ahmad I, Javed M, Rehman S, et al.. Injection sclerotherapy of bleeding gastric varices using absolute alcohol. J Pak Med Inst 2010;24(02):111-114.

Khan A, Manan F, ud-Din R. Outcome of endoscopic band ligation. Gomal J Med Sci 2013;11(1):88-91.

Bosch J, Abraldes JG, Groszmann R. Current management of portal hypertension. J Hepatol Supple 2003;38(1): S54-S68.

https://doi.org/10.1016/s0168-8278(02)00430-0

Sarin SK, Jain AK, Lamba GS, Gupta R, Chowdhary A. Isolated gastric varices: prevalence, clinical relevance and natural history. Dig Surg 2003;20(1):42-47. https://doi.org/10.1159/000068865

Hosking SW, Johnson AG. Gastric varices: a proposed classification leading to management. Br J Surg. 1988;75(3):195-196. https://doi.org/10.1002/bjs.1800750303

Hashim R, Hussain AB, Rehman K. Seroprevalence of Hepatitis-C virus antibodies among healthy young men in Pakistan. Pak J Med Res 2005; 44:140-142.

Khan MS, Khalid M, Ayub N, Javed M. Seroprevalence and risk factors of Hepatitis C virus (HCV) in Mardan, N.W.F.P. Rawal Med J 2004;29:57-60.

Farooqi JI, Jafri SM, Najib-ul-Haq, Niaz SK, Hamid S, Abbas Z, et al.. Management of variceal bleeding: PSG guidelines 2006. J Pak Med Assoc 2007;57(10):505-511.

Svoboda P, Konecny M, Martinek A, Hrabovsky V, Prochazka V, Ehrmann J, et al. Acute upper gastrointestinal bleeding in liver cirrhosis patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012;156(3):266-270.

https://doi.org/10.5507/bp.2012.029

D’Amico G, Pietrosi G, Tarantino I, Pagliaro L. Emergency sclerotherapy versus vasoactive drugs for variceal bleeding in cirrhosis: a Cochrane meta-analysis. Gastroenterol 2003;124(5):1277-1291.

https://doi.org/10.1016/s0016-5085(03)00269-5