Romcea Anca Alexandra, Tanţău Marcel, Seicean Andrada, Pascu Oliviu
The study was performed at the "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology of Cluj-Napoca, Romania.
Clujul Med. 2013;86(1):21-3. Epub 2013 Feb 4.
To investigate the etiology of upper digestive hemorrhage in cirrhotic patients.
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.
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.
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.
探讨肝硬化患者上消化道出血的病因。
2004年11月至2006年12月，我们在克卢日-纳波卡“O. 福多尔”地区胃肠病学和肝病研究所进行了一项前瞻性研究。该研究基于内镜检查记录，对1284例食管静脉曲张患者进行，根据临床、生化和内镜信息诊断为肝硬化，并记录在观察表中。在定期检查期间，我们观察并监测患者的静脉曲张性和非静脉曲张性出血情况。
本研究纳入的1284例患者中，有297例发生上消化道出血，主要病因是静脉曲张破裂出血（217例 - 73%），80例（27%）为上消化道非静脉曲张性出血。十二指肠溃疡是本研究中肝硬化患者上消化道非静脉曲张性出血的主要原因（33.75%），其次是胃溃疡（21.25%）、门静脉高压性胃病（17.5%）、急性糜烂性胃炎（11.25%）、马洛里-魏斯综合征（6.25%）、食管溃疡（5%）、胃窦血管扩张症（1.25%）、十二指肠息肉（1.25%）和溃疡型胃癌（1.25%）。我们还观察了静脉曲张出血患者组中的出血复发情况。静脉曲张破裂出血在每个Child-Pugh临床分级中均占主导，但必须指出，静脉曲张破裂的风险随肝病严重程度增加而升高。有8例死亡，均由食管静脉曲张破裂出血导致。
在我们的研究中，近27%的肝硬化上消化道出血患者出血源于非静脉曲张性病因，最常见的病因是消化性溃疡。静脉曲张破裂出血比非静脉曲张性出血更严重，死亡率更高。
