BIOCHEMICAL AND ENDOSCOPIC EVALUATION OF UPPER-GASTROINTESTINAL BLEED IN PATIENTS WITH LIVER CIRRHOSIS
Objectives: Evaluating the causes of UGIB, their relation with Child-Turcotte-Pugh (CTP) score and biochemicalmarkers and the predictors of varices.
Study Design: Prospective comparative study.
Place and Duration of Study: Fauji Foundation Hospital Rawalpindi, from Jan 2016 to Jul 2017.
Methodology: The study population consisted of 256 patients with chronic liver disease who underwent upper gastrointestinal endoscopy to evaluate the cause of UGIB. Both variceal and non-variceal causes were notified. The patients were classified into class A, B and C according to CTP score. The relationship of varices with CTP score and biochemical findings were studied. The predictors of varices were also found by regression analysis.
Results: Gastroesophageal varices were present in 73.6% patients and 26.3% patients had non-variceal bleeding. Portal hypertensive gastropathy was the most common cause of non-variceal bleeding (20.5%). The presence and grades of varices were associated with CTP score (p<0.05). Class C had more advanced varices compared to Class A. Low platelets and albumin while high bilirubin, PT, INR and CTP class were prognosticators of varices.
Conclusion: Although a substantial portion bleeds due to variceal haemorrhage, non-variceal causes of UGIB were also not uncommon. Both pathologies resulted in substantial mortality. The advanced liver cirrhosis was associated with higher grades of varices. Blood chemistry markers helped in differentiating the two causes and manage them accordingly.