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Korean J Helicobacter  Up Gastrointest Res > Volume 13(4); 2013 > Article
The Korean Journal of Helicobacter  and Upper Gastrointestinal Research 2013;13(4):235-242.
DOI: https://doi.org/10.7704/kjhugr.2013.13.4.235    Published online December 10, 2013.
The Clinical Features and Prognostic Factors of Nonvariceal Upper Gastrointestinal Bleeding in the Patients with Liver Cirrhosis
Yoon Won Jo, Ja Yoon Choi, Chang Yoon Ha, Hyun Ju Min, Ok Jae Lee
1Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea. ojlee@gnu.ac.kr
2Gyeongsang Institute of Health Sciences, Jinju, Korea.
간경변증 환자에서 비정맥류 상부위장관 출혈의 임상양상 및 예후인자
조윤원1, 최자윤1, 하창윤1,2, 민현주1,2, 이옥재1,2
경상대학교 의학전문대학원 내과학교실1, 경상대학교 건강과학연구원2
Abstract
BACKGROUND/AIMS
Variceal rupture is the most common cause of upper gastrointestinal bleeding (UGIB) in cirrhotic patients and is well investigated. However, there are few documented studies on nonvariceal UGIB (NVUGIB) in these patients. This study was conducted to evaluate clinical features, in-hospital mortality rate and factors associated with mortality in cirrhotic patients with NVUGIB. MATERIALS AND METHODS: Among 399 cirrhotic patients who presented UGIB at Gyeongsang National University Hospital during 5 years since January 2007, patients with NVUGIB were selected by retrospective review of medical records. The patients' clinical and endoscopic findings, treatment outcomes, in-hospital mortality rates and its risk factors were investigated. RESULTS: NVUGIB was documented in 83 patients (20.8%). Mean age was 60.7+/-9.7 years, 85.5% was male. Child-Pugh class was A or B in 88%. Initial hemodynamic instability was reported in 25.3%, and 65.1% required blood transfusions. The major bleeding source was peptic ulcer 95.2% (79/83), and 44.6% (37/83) had endoscopic high risk bleeding stigmata and required endoscopic hemostasis. Rebleeding rate was 7.2% and in-hospital mortality rate was 8.4%. Hemodynamic instability (71.4% vs. 22.4%, P=0.013) and rebleeding (57.1% vs. 2.6%, P=0.000) were more frequent in the mortality group compared to the survival group. Hemodynamic instability was the risk factor for mortality at univariate and multivariate analyses. CONCLUSIONS: NVUGIB accounted for 20.8% of UGIB in liver cirrhosis and its development was not related to liver function. Peptic ulcer was the major cause and 45% required endoscopic hemostasis. It's in-hospital mortality rate was 8.4%, and hemodynamic instability was an independent risk factor of mortality in NVUGIB.
Key Words: Liver cirrhosis; Nonvariceal upper gastrointestinal bleeding; Mortality


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