Circadian pattern of acute variceal bleeding in Egyptian patients

ABSTRACT

Chronic liver disease leading to cirrhosis is the most common cause of portal hypertension which may end in serious bleeding from gastro-oesophageal varices. Recent studies have demonstrated a daily pattern of acute upper gastrointestinal bleeding in patients with liver cirrhosis evidenced by one or two peaks throughout the day. The assessment of the circadian rhythm of acute variceal bleeding with the possible participation of circadian changes of the fibrinolytic parameters. The study included 264 patients with liver cirrhosis and upper gastrointestinal bleeding in addition to 20 healthy subjects as a control group. The assessment of fibrinolytic parameters was completed in 60 of the patient group in addition to the control group. The fibrinolytic activity was assessed by estimation of Tissue plasminogen activator antigen [tPA Ag] and Plasminogen activator inhibitor antigen [PAI-1 Ag], the latter is considered the fast acting inhibitor of plasminogen activators. We observed statistically significant 2 time peaks of upper gastrointestinal bleeding at hour 0400 and hour 1700 with overlapping peak of the fibrinolytic parameter, tissue plasminogen activator antigen, with the night peak of bleeding. There are 2 time peaks of upper gastrointestinal bleeding with a temporal association between the night peak and a relative hyperfibrinolytic state