Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Department of Surgery, University of Vermont, Burlington, VT, USA.
Scand J Gastroenterol. 2024 Sep;59(9):1081-1086. doi: 10.1080/00365521.2024.2386451. Epub 2024 Aug 6.
Upper gastrointestinal bleeding (GIB) in patients has been well-characterized in liver cirrhosis but studies on lower GIB are limited. The clinical characteristics, management and outcomes in patients with and without liver cirrhosis was compared to determine the overall features of GIB in patients with liver cirrhosis compared with non-cirrhotics.
A retrospective study on cirrhotics hospitalized for GIB 2010-2021, matched with control group of non-cirrhotics (1:4) for upper vs. lower GIB. Patients with overt bleeding leading to hospitalization were included.
Overall, 396 patients had cirrhosis, 267 (67%) men, median age 62, alcoholic etiology 177/396 (45%), median MELD 12 (range 6-32). Overall 102 cirrhotics had GIB, matched with 391 non-cirrhotics. Overall 87 (85%) cirrhotic patients had upper and 15% lower GIB. Compared to non-cirrhotics, the cause of GIB was more commonly acute variceal bleeding (AVB) (42% vs. 1%), hemorrhoids 40% vs. 6% ( = 0.002), less commonly gastric ulcer 13% vs. 31% ( < 0.001), duodenal ulcer 9% vs. 29% ( < 0.001), 5% of cirrhotics used NSAIDs vs. 26% of controls ( < 0.001). Rebleeding occurred in 14% of cirrhotics vs. 3% in controls ( < 0.001). Only one cirrhotic patient (1%) died from GIB vs. 0.8% of controls within 45 days. Overall mortality 45 days after hospitalization was 10% in cirrhotics vs. 5% in controls ( < 0.001).
Bleeding from gastric and duodenal ulcers were less common in cirrhotics than in controls. Bleeding from hemorrhoids was more common in cirrhotics. Mortality due to GIB was low in both groups but overall mortality was significantly higher in cirrhotics.
上消化道出血（GIB）在肝硬化患者中已有很好的描述，但下 GIB 的研究有限。本研究比较了有和无肝硬化患者的临床特征、治疗和结局，以确定肝硬化患者 GIB 的总体特征与非肝硬化患者相比。
对 2010 年至 2021 年因 GIB 住院的肝硬化患者进行回顾性研究，将上消化道出血与下消化道出血的对照组患者按 1:4 配对。纳入因显性出血导致住院的患者。
共有 396 例患者患有肝硬化，267 例（67%）为男性，中位年龄为 62 岁，酒精性病因 177/396（45%），中位 MELD 为 12 分（范围 6-32 分）。共有 102 例肝硬化患者发生 GIB，与 391 例非肝硬化患者相匹配。总的来说，87%（85%）的肝硬化患者有上消化道出血，15%有下消化道出血。与非肝硬化患者相比，GIB 的病因更常见急性静脉曲张出血（AVB）（42% vs. 1%），痔疮 40% vs. 6%（=0.002），较少见胃溃疡 13% vs. 31%（<0.001），十二指肠溃疡 9% vs. 29%（<0.001），5%的肝硬化患者使用非甾体抗炎药（NSAIDs），而对照组为 26%（<0.001）。再出血发生率在肝硬化患者中为 14%，对照组为 3%（<0.001）。仅有 1 例（1%）肝硬化患者因 GIB 死亡，对照组为 0.8%，45 天内。肝硬化患者住院后 45 天总体死亡率为 10%，对照组为 5%（<0.001）。
与对照组相比，肝硬化患者胃和十二指肠溃疡出血较少见。肝硬化患者痔疮出血更常见。两组因 GIB 导致的死亡率均较低，但肝硬化患者的总体死亡率明显更高。
