Clinical features and treatment outcomes of upper gastrointestinal bleeding in patients with cirrhosis

Abstract

With recent progress in treatment modalities, mortality from upper gastrointestinal (UGI) bleeding has decreased appreciably. The aim of this study was to establish how UGI bleeds are managed in Korean patients with cirrhosis and to evaluate treatment outcomes. A total of 479 episodes of acute UGI bleeding in 464 patients with cirrhosis were included during a six-month period at nine tertiary medical centers. Treatment outcomes were assessed by failure to control bleeding, rebleeding and mortality. The source of bleeding was esophagogastric varices in 77.7% of patients, nonvariceal lesions in 15.9%, and undefined in 6.5%. For control of bleeding, endoscopic and pharmacologic treatments were used in 74.7% and 81.9% of patients, respectively. Variceal ligation was a major technique for endoscopic treatment (90%), and terlipressin and somatostatin were the main pharmacologic agents used (96.4%). Initial hemostasis was achieved in 86.8% of cases, but rebleeding occurred in 3.8% and 16.8% of cases within five days and six weeks of hemorrhage, respectively. Five-day and six-week mortality were 11.3% and 25.9%, respectively. Survival of patients with variceal bleeding seems to be remarkably improved than previous reports, which may suggest the advances in hemostatic methods for control of variceal hemorrhage.

Fig. 1

Cumulative incidence of rebleeding after hemostasis according to the source of initial bleeding in 448 patients with known source of bleeding. Thirty-one patients with bleeding from undefined sources were excluded in this analysis. The p value was obtained from the log-rank test.

Fig. 2

(A) Cumulative mortality according to the source of initial bleeding in 448 patients with known source of bleeding. Thirty-one patients with bleeding from undefined sources were excluded in this analysis. (B) In this figure, patients with bleeding from undefined sources were included in patients with variceal bleeding. The p value was obtained from the log-rank test.

Fig. 3

Cumulative mortalities according to the Child-Pugh class of (A) 448 patients with known sources of bleeding and (B) 372 patients with variceal bleeding. Thirty-one patients with bleeding from undefined sources were excluded in this analysis. The p values were obtained from the log-rank test. Child A, patients with Child-Pugh class A; Child B, patients with Child-Pugh class B; Child C, patients with Child-Pugh class C.