Lower Gastrointestinal Bleeding in Patients with Liver Cirrhosis: Prevalence, Outcomes, and Correlation with MELD Score in an Indian Tertiary Care Facility
DOI:
https://doi.org/10.54133/ajms.v6i1.377Keywords:
liver cirrhosis, gastrointestinal bleed, MELD score, portal hypertensionAbstract
Background: Lower gastrointestinal bleeding (LGIB) is responsible for 25 percent of overall GI bleeding patients in the general population. In the US, the LGIB incidence is thought to be 21–27/100,000 per year, while the rate of hospitalization is thought to be 20–30/100,000 per year. According to reports, 2–4% of patients hospitalized with LGIB die. Despite the fact that upper GI complications associated with portal hypertension have received a lot of attention, few studies have explored lower GI complications. Objective: To study the prevalence and 28-day outcome of patients hospitalized with lower gastrointestinal bleeding in liver cirrhosis and its correlation with the model for end-stage liver disease (MELD). Method: A single center-based cross-sectional study was conducted for a duration of eighteen months. The main source of data is from patients hospitalized at the Department of General Medicine and Department of Medical Gastroenterology at the Institute of Medical Sciences and SUM hospital, with a minimum of 100 cases. Results: Out of 100 patients, internal hemorrhoids were observed in 50 patients, external hemorrhoids were found only in 1 patient, and rectal varices were present in 17 patients. The MELD score for the 28th day outcome was found to be 21.85 on follow-up. It was 27.0 in discharged patients by the 28th day. Conclusions: An essential element of the condition, portal hypertension, appears to be responsible for the poor prognosis.
Downloads
References
Rockey DC. Lower gastrointestinal bleeding. Gastroenterology. 2006;130(1):165-171. doi: 10.1053/j.gastro.2005.11.042. DOI: https://doi.org/10.1053/j.gastro.2005.11.042
Strate LL. Lower GI bleeding: epidemiology and diagnosis. Gastroenterol Clin North Am. 2005;34(4):643-664. doi: 10.1016/j.gtc.2005.08.007. DOI: https://doi.org/10.1016/j.gtc.2005.08.007
Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1997;92(3):419-424. PMID: 9068461.
Sauerbruch T, Schierwagen R, Trebicka J. Managing portal hypertension in patients with liver cirrhosis. F1000Res. 2018;7:F1000 Faculty Rev-533. doi: 10.12688/f1000research.13943.1. DOI: https://doi.org/10.12688/f1000research.13943.1
Misra SP, Dwivedi M, Misra V. Prevalence and factors influencing hemorrhoids, anorectal varices, and colopathy in patients with portal hypertension. Endoscopy. 1996;28(4):340-345. doi: 10.1055/s-2007-1005477. DOI: https://doi.org/10.1055/s-2007-1005477
Diaz-Sanchez A, Nuñez-Martinez O, Gonzalez-Asanza C, Matilla A, Merino B, Rincon D, et al. Portal hypertensive colopathy is associated with portal hypertension severity in cirrhotic patients. World J Gastroenterol. 2009;15(38):4781-4787. doi: 10.3748/wjg.15.4781. DOI: https://doi.org/10.3748/wjg.15.4781
de Franchis R; Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63(3):743-752. doi: 10.1016/j.jhep.2015.05.022. DOI: https://doi.org/10.1007/978-3-319-23018-4_1
McCullough AJ. Epidemiology of the metabolic syndrome in the USA. J Dig Dis. 2011;12(5):333-340. doi: 10.1111/j.1751-2980.2010.00469.x. DOI: https://doi.org/10.1111/j.1751-2980.2010.00469.x
Babar IA, Cheng CJ, Booth CJ, Liang X, Weidhaas JB, Saltzman WM, et al. Nanoparticle-based therapy in an in vivo microRNA-155 (miR-155)-dependent mouse model of lymphoma. Proc Natl Acad Sci USA. 2012;109(26):E1695-704. doi: 10.1073/pnas.1201516109. DOI: https://doi.org/10.1073/pnas.1201516109
Wang TF, Lee FY, Tsai YT, Lee SD, Wang SS, Hsia HC, et al. Relationship of portal pressure, anorectal varices and hemorrhoids in cirrhotic patients. J Hepatol. 1992;15(1-2):170-173. doi: 10.1016/0168-8278(92)90031-j. DOI: https://doi.org/10.1016/0168-8278(92)90031-J
Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838-851. doi: 10.1016/S0140-6736(08)60383-9. DOI: https://doi.org/10.1016/S0140-6736(08)60383-9
Sanz-García C, Fernández-Iglesias A, Gracia-Sancho J, Arráez-Aybar LA, Nevzorova YA, Cubero FJ. The space of Disse: The liver hub in health and disease. Livers. 2021;1(1):3-26. doi: 10.3390/livers1010002. DOI: https://doi.org/10.3390/livers1010002
Tiwari PS, Kc S, Sharma D, Paudel MS, Mandal A. Prevalence of portal hypertensive gastropathy in chronic liver disease and correlation with the severity of liver disease. Cureus. 2019;11(8):e5454. doi: 10.7759/cureus.5454. DOI: https://doi.org/10.7759/cureus.5454
Wong F. Portal hypertensive gastropathy. Gastroenterol Hepatol (N Y). 2007;3(6):428-473. PMID: 23329900.
Chalasani N, Kahi C, Francois F, Pinto A, Marathe A, Bini EJ, et al. Model for end-stage liver disease (MELD) for predicting mortality in patients with acute variceal bleeding. Hepatology. 2002;35(5):1282-1284. doi: 10.1053/jhep.2002.32532. DOI: https://doi.org/10.1053/jhep.2002.32532
Bishay K, Tandon P, Fisher S, Yelle D, Carrigan I, Wooller K, et al. Clinical factors associated with mortality in cirrhotic patients presenting with upper gastrointestinal bleeding. J Can Assoc Gastroenterol. 2020;3(3):127-134. doi: 10.1093/jcag/gwy075. DOI: https://doi.org/10.1093/jcag/gwy075
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 )
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Published by Al-Rafidain University College. This is an open access journal issued under the CC BY-NC-SA 4.0 license (https://creativecommons.org/licenses/by-nc-sa/4.0/).
