Erosive Gastritis and Acute Gastroduodenal Ulcerations as Source of Upper Gastrointestinal Bleeding in Liver Cirrhosis

Abstract

This retrospective study was initiated to compare the frequency of acute gastric mucosal lesions (AGML) (including erosive gastritis and acute gastroduodenal ulcerations) in patients with and without liver cirrhosis. 466 upper gastrointestinal bleeders were reviewed, including 167 cirrhotic and 299 noncirrhotic patients. In all of them, emergency esophagoscopy and/or gastroscopy were performed, followed by immediate upper GI X-ray examination. The overall incidence of AGML in cirrhotic and in noncirrhotic upper GI bleeders was high but very similar (38.0 and 41.8%, respectively). This speaks against the significance of liver cirrhosis and portal hypertension as etiologic factors in AGML. Bleeding esophageal varices were the sole cause of upper GI bleeding in 51.5% of our cirrhotics. The frequency of chronic gastric or duodenal ulcer in liver cirrhosis as the cause of bleeding in our city hospital population was less than ¼ of that seen in noncirrhotic bleeders. Excessive alcoholic intake just preceding the bleeding was found in about 45% of cirrhotic and noncirrhotic patients with AGML and in about ²/₃ of the cirrhotics who bled from esophageal varices. The chronic alcoholism was equally frequent in cirrhotics who bled from AGML and those who bled from varices. About 40% of cirrhotics with variceal bleeding expired, but the mortality of cirrhotics bleeding from AGML was less than 10%. The importance of the early endoscopic diagnosis of the source of the upper GI bleeding in cirrhotics is self-evident for prognostic evaluation and therapeutic planning, both of which are different in bleeding from esophageal varices and from AGML.