[Propranolol and 5-isosorbide mononitrate in patients with cirrhosis: systemic and portal hemodynamic events]. / Propranolol y 5-mononitrato de isosorbide en pacientes con cirrosis: episodios hemodinámicos sistémicos y portales.

AIM: To study the acute variations in portal and systemic hemodynamics after propranolol and 5-isosorbide mononitrate (IMN) administration in cirrhotic patients. PATIENTS AND METHODS: Seventeen cirrhotic patients with portal hypertension were studied with catheterization and Doppler duplex Ultrasound Systemic hemodynamics. Hepatic venous pressure gradient (HVPG), portal blood flow and resistance were evaluated in baseline, after intravenous propranolol (0.15 mg/kg), and after 20 mg p.o. of IMN. Patients who showed a decrease > or = 20% and/or < 12 mm/hg in HVPG were considered responders. RESULTS: There were no significant differences in clinical or portal hemodynamic baseline data between responders and non-responders to the drugs. After propranolol administration cardiac index decreased (p < 0.05) and pulmonary capillary pressure increased (p < 0.0001). Six patients (35%) were responders; lack of response was associated with an insufficient decrease in portal blood flow or with an increase in portal resistance. After IMN administration cardiac index decreased (p < 0.05) with normalization of pulmonary capillary pressure (p < 0.05). Seven patients were responders to the addition of IMN (5 non-responders to propranolol) and showed a decrease in HVPG associated with a reduction in portal blood flow and resistance; in the remaining 10 patients HVPG did not decrease despite a reduction in portal blood flow, with an increase in portal resistance. CONCLUSIONS: Addition of IMN increased the number of responders and reduced portal blood flow with a variable effect in portal resistance.

Detection of hepatitis G virus RNA in patients with acute non-A-E hepatitis.

We investigated the possible role of hepatitis G virus (HGV or GBV-C) in the aetiology of acute non-A-E hepatitis in Argentina by detecting viral RNA in sera by reverse transcriptase-polymerase chain reaction (RT-PCR) using primers specific for the putative NS3 helicase region of HGV. Sixty two patients with acute hepatitis were included in this study. The absence of hepatitis A-E was confirmed by serological testing, and all patients were negative for HCV RNA and autoimmune markers. All patients denied alcohol intake and the use of hepatotoxic drugs. Their mean age was 35.3 years and 37 were males. HGV RNA was present in 19/62 (30.6%) of the patients with non-A-E acute hepatitis. Among HGV-positive patients, three had parenteral risk factors within 3 months of onset, one was a health care worker, one was sexually promiscuous, one had travelled to the Middle East and 13 (68.4%) had no history of parenteral exposure. Epidemiological, clinical and biochemical features between HGV-positive and negative patients did not achieve statistical significance. Hence, HGV appears to play a role in the pathogenesis of acute viral hepatitis; however, the etiology of a significant number of hepatitis cases remains unclear, suggesting the existence of an additional agent(s). The absence of parenteral exposure in most of the HGV RNA-positive patients in this study shows that routes of community-acquired HGV infection are not yet completely understood.

[Evaluation of propranolol response by catheterization and Doppler ultrasonography in patients with cirrhosis]. / Evaluación de la respuesta al propranolol por cateterismo y ecografía Doppler en pacientes con cirrosis.

AIMS: To analyze the changes in portal pressure, blood flow and resistance after propranolol administration, and to assess the predictive value of the variations of Doppler Duplex Ultrasonography (DDU) measurements according to the response of the hepatic venous pressure gradient (HVPG). PATIENTS & METHODS: 30 cirrhotic patients were studied. Assessment of systemic hemodynamics and HVPG were performed in baseline and after intravenous propranolol administration (0.15 mg/kg). Patients who showed a decrease > or = 20% &/or < 12 mm/Hg in HVPG were considered responders. The DDU study was performed in blind conditions, in baseline and after propranolol. Measurement of blood flow of the portal vein, splenic vein and femoral artery were performed. Portal resistance was calculated as HVPG/portal blood flow. RESULTS: All patients were beta blocked and 14 (47%) were responders. There were no significant differences in systemic or splachnic hemodynamic baseline data between responders and non responders. Femoral blood flow decreased in both groups. Splenic and portal blood flow decreased significantly only in responders. No significant difference was found in the variation of portal resistance between responders and non responders; when these changes were considered individually, a great variability was found in both groups. A decrease > or = 15% in splenic blood flow showed a positive predictive value of 88%, a lack of a similar decrease in portal blood flow showed a negative predictive value of 86%. CONCLUSIONS: The decrease in portal blood flow was the main factor in determining the response to propranolol.

Evaluacion de la respuesta al propranolol por cateterismo y ecografia Doppler en pacientes con cirrosis / Evaluation of the propranolol response by catheterization and Doppler ultrasonography in patients with cirrhosis

Objectivo: analizar los cambios en la presión, flujo y resistencia portal luego de la administración de propranolol, y determinar el valor predictivo de las variaciones de flujo de las venas porta y esplénica de acuerdo a la respuesta en el gradiente de presión de venas suprahepáticas (GPVH). Pacientes y método: en 30 pacientes cirróticos se realizó catetrismo con mediciones hemodinámicas sistémicas y portales en condiciones basales y luego de la administración de propranolol I.V. (0,15mg/kg); quienes mostraron una disminución del GPVH>20 por ciento y/ó <12 mm/hg fueron considerados respondedores. El estudio de ecografía Doopler fue realizado en condiciones basales y post propranolol, con mediciones de flujo en vena porta, vena esplénica y arteria femoral. La resistencia portal se calculó como GPVH / flujo portal. Resultados: todos los pacientes presentaron beta-bloqueo, 14 (47 por ciento) fueron respondedores. No hubo diferencias significativas en la hemo dinámica sistémica o portal basal entre respondedores y no respondedores. Luego del propranolol, el flujo femoral disminuyó en ambos grupos; el flujo en venas porta y esplénica disminuyó significativamente sólo en los respondedores. No hubo diferencias entre respondedores y no respondedores en los cambios de la resistencia portal, aunque se observó gran variabilidad en ambos grupos. Un desceno > 15 por ciento en el flujo de la vena esplénica mostró un valor predictivo positivo de 88 por cento, la falta de disminución del flujo portal > 15 por ciento presentó un valor predictivo negativo del 86 por ciento. Conclusión: la disminución en el flujo portal fue el factor más importante en determinar la respuesta al propranolol. (AU)

Evaluacion de la respuesta al propranolol por cateterismo y ecografia Doppler en pacientes con cirrosis / Evaluation of the propranolol response by catheterization and Doppler ultrasonography in patients with cirrhosis

Objectivo: analizar los cambios en la presión, flujo y resistencia portal luego de la administración de propranolol, y determinar el valor predictivo de las variaciones de flujo de las venas porta y esplénica de acuerdo a la respuesta en el gradiente de presión de venas suprahepáticas (GPVH). Pacientes y método: en 30 pacientes cirróticos se realizó catetrismo con mediciones hemodinámicas sistémicas y portales en condiciones basales y luego de la administración de propranolol I.V. (0,15mg/kg); quienes mostraron una disminución del GPVH>20 por ciento y/ó <12 mm/hg fueron considerados respondedores. El estudio de ecografía Doopler fue realizado en condiciones basales y post propranolol, con mediciones de flujo en vena porta, vena esplénica y arteria femoral. La resistencia portal se calculó como GPVH / flujo portal. Resultados: todos los pacientes presentaron beta-bloqueo, 14 (47 por ciento) fueron respondedores. No hubo diferencias significativas en la hemo dinámica sistémica o portal basal entre respondedores y no respondedores. Luego del propranolol, el flujo femoral disminuyó en ambos grupos; el flujo en venas porta y esplénica disminuyó significativamente sólo en los respondedores. No hubo diferencias entre respondedores y no respondedores en los cambios de la resistencia portal, aunque se observó gran variabilidad en ambos grupos. Un desceno > 15 por ciento en el flujo de la vena esplénica mostró un valor predictivo positivo de 88 por cento, la falta de disminución del flujo portal > 15 por ciento presentó un valor predictivo negativo del 86 por ciento. Conclusión: la disminución en el flujo portal fue el factor más importante en determinar la respuesta al propranolol.

[The problem of hepatitis C virus infection in blood donors. Clinico-epidemiological, virological and histological evaluation]. / Problemática de la infección por el virus de la hepatitis C en donantes de sangre. Evaluación Clínico-epidemiologica, virologica e hestologica.

Our aim was to identify prospectively, with a case-control survey, risk factors for hepatitis C virus (HCV) infection in volunteer blood donors and to assess the histological features and their correlation with transaminase (ALT) level and viremia. In a Liver Unit of a referral-based University Hospital, 248 blood donors were evaluated for risk factors, according to definitive ELISA test and 132 were considered true positive. Of these, 132 anti-HCV(+) blood donors were age and sex-matched with the anti-HCV-negative group (n = 116). There was a high frequency in the anti-HCV(+) group of intravenous drug abuse (IVDA) (22%), history of major surgery (20.4%), tattooing (12.1%), non IVDA (17.4%), and multiple sexual partners or history of sexual transmitted diseases (25.7%). At least one risk factor was identified in 76.52% of the antiHCV(+) donors vs 34.4% in the anti-HCV (-) group (p = 0.000). A total of 71 patients accepted a liver biopsy; chronic liver disease was present in 85.9% (n = 61) (mean Knodell score 6.75). ALT was elevated in 69% (n = 49) and HCV RNA was detectable in 76% of patients. It can be concluded that in our study 76.5% of anti HCV positive blood donors showed at least one risk factor for HCV infection detected by a second highly efficient interview. Twenty two percent admitted to prior intravenous drug use although this disqualifies them for blood donation, but was not identified by the screening process. Most blood donors with anti HCV(+) had chronic hepatitis C regardless of their serum ALT levels. Normal ALT did not exclude liver disease.

[Interferon alfa in the treatment of chronic hepatitis C: course of 24 versus 48 weeks. Results of a randomized trial]. / Interferon alfa en el tratamiento de la hepatitis crónica C: curso de 24 versus 48 semanas. Resultados de un estudio randomizado.

UNLABELLED: The aim of this trial was to investigate if a more prolonged course of interferon (IFN) is able to increase the long-term benefit in patients with chronic hepatitis C. Forty-four patients with active chronic hepatitis and antibodies to HCV were randomly assigned to receive IFN-alfa 2b 3 MU t.i.w. during 24 weeks (group I, n 23) or during 48 weeks (group II, n 21). In the evaluation of results, complete response was considered when the ALT values returned to normality during the treatment; and sustained response, when the ALT values persisted below normal range during at least 6 months post therapy. Histologic changes were compared by using the Histological Activity Index, or Knodell score. Viremia status was evaluated for the study of HCV RNA (by nested-RT-PCR). RESULTS: There were no significant differences between both groups before treatment, in terms of age, sex, ALT, or histologic findings (11 patients in group I, and 7 in group II had cirrhosis). Complete response was found in 9 patients (39.1%) from group I; in 11 (52.4%) from group II (NS). Basal histologic findings were identified as the only predictive factor of complete and sustained response, by logistic regression analysis. Considering only noncirrhotic patients, complete response was seen in 58.3% in patients from group I, 71.4% in group II. Sustained response was obtained in 4 patients from group I, (17.4%), 7 from group II (33.3%) (NS). Post IFN liver biopsies were performed in 23 patients (12 from group I, 11 from group II). In group I patients, there were no significant changes. In group II, Knodell score was found to be significantly decreased post IFN [pre IFN, median 10, range 3-15; post IFN, median 6, range 2-14] (p < 0.05). HCV RNA was absent in serum during the follow-up post IFN in 2 patients from group I, in 3 from group II. The results of this study show that a 48 weeks course of IFN has a trend to achieve a higher sustained response than the usual regime (but non significant); and it produces a decrease in the histologic activity. The best predictive factor of positive response was the absence of cirrhosis in our study (although we did not evaluate viral factors, such as genotypes or HCV viremia levels).

Interferon alfa en el tratamiento de la hepatitis cronica C: curso de 24 versus 48 semanas. Resultados de un estudio randomizado / Interferon alfa in the treatment of chronic hepatitis C: course of 24 versus 48 weeks. Results of a randomized trial

The aim of this trial was to investigate if a more prolonged course of interferon (IFN) is able to increase the long-term benefit in patients with chronic hepatitis C. Forty-four patients with active chronic hepatitis and antibodies to HCV were randomly assigned to receive IFN-alfa 2b 3 MU t.i.w. during 24 weeks (group I, n 23) or during 48 weeks (group II, n 21). In the evaluation of results, complete response was considered when the ALT values returned to normality during the treatment; and sustained response, when the ALT values persisted below normal range during at least 6 months post therapy. Histologic changes were compared by using the Histological Activity Index, or Knodell score. Viremia status was evaluated for the study of HCV RNA (by nested-RT-PCR). Results: There were no significant differences between boths groups before treatment, in terms of age, sex, ALT, or histologic findings (11 patients in group I, and 7 in group II had cirrhosis). Complete response was found in 9 patients (39.1 per cent) from group I; in 11 (52.4 per cent) from group II (NS). Basal histologic findings were identified as the only predictive factor of complete and sustained response, by logistic regresion analysis. Considering only noncirrhotic patients, complete response was seen in 58.3 per cent in patients from group I, 71.4 per cent in group II. Sustained response was obtained in 4 patients from group I, (17.4 per cent), 7 from group II (33.3 per cent) (NS). Post IFN liver biopsies were performed in 23 patients (12 from group I, 11 from group II). In group I patients, there were no significant changes. In group II, Knodell score was found to be significantly decreased post IFN (pre IFN, median 10, range 3-15; post IFN, median 6, range 2-14) (p<0.05). HCR RNA was absent in serum during the follow-up post IFN in 2 patients from group I, in 3 from group II. The results of this study show that a 48 weeks course of IFN has a trend to achieve a higher sustained response than the usual regime (but non significant); and it produces a decrease in the histologic activity. The best predicitve factor of positive response was the absence of cirrhosis in our study (although we did not evaluate viral factors, such as genotypes or HCV viremia levels). (AU)

Interferon alfa en el tratamiento de la hepatitis cronica C: curso de 24 versus 48 semanas. Resultados de un estudio randomizado / Interferon alfa in the treatment of chronic hepatitis C: course of 24 versus 48 weeks. Results of a randomized trial

The aim of this trial was to investigate if a more prolonged course of interferon (IFN) is able to increase the long-term benefit in patients with chronic hepatitis C. Forty-four patients with active chronic hepatitis and antibodies to HCV were randomly assigned to receive IFN-alfa 2b 3 MU t.i.w. during 24 weeks (group I, n 23) or during 48 weeks (group II, n 21). In the evaluation of results, complete response was considered when the ALT values returned to normality during the treatment; and sustained response, when the ALT values persisted below normal range during at least 6 months post therapy. Histologic changes were compared by using the Histological Activity Index, or Knodell score. Viremia status was evaluated for the study of HCV RNA (by nested-RT-PCR). Results: There were no significant differences between boths groups before treatment, in terms of age, sex, ALT, or histologic findings (11 patients in group I, and 7 in group II had cirrhosis). Complete response was found in 9 patients (39.1 per cent) from group I; in 11 (52.4 per cent) from group II (NS). Basal histologic findings were identified as the only predictive factor of complete and sustained response, by logistic regresion analysis. Considering only noncirrhotic patients, complete response was seen in 58.3 per cent in patients from group I, 71.4 per cent in group II. Sustained response was obtained in 4 patients from group I, (17.4 per cent), 7 from group II (33.3 per cent) (NS). Post IFN liver biopsies were performed in 23 patients (12 from group I, 11 from group II). In group I patients, there were no significant changes. In group II, Knodell score was found to be significantly decreased post IFN (pre IFN, median 10, range 3-15; post IFN, median 6, range 2-14) (p<0.05). HCR RNA was absent in serum during the follow-up post IFN in 2 patients from group I, in 3 from group II. The results of this study show that a 48 weeks course of IFN has a trend to achieve a higher sustained response than the usual regime (but non significant); and it produces a decrease in the histologic activity. The best predicitve factor of positive response was the absence of cirrhosis in our study (although we did not evaluate viral factors, such as genotypes or HCV viremia levels).

[Isosorbide-5-mononitrate in the prevention of digestive hemorrhage in cirrhosis: randomized study]. / 5 mononitrato de isosorbide en la prevención de la hemorragia digestiva en cirrosis: estudio randomizado.

Isosorbide 5-mononitrate (5MI) is a preferential venous dilator that has been shown to decrease portal pressure in acute and long-term haemodynamic studies, and this is not associated with adverse effects on hepatic perfusion. The aim of this trial was to investigate the efficacy and safety of 5MI in the prevention of upper gastrointestinal bleeding in cirrhotic patients. Forty two cirrhotic patients with F2 or F3 esophageal varices showing "red signs" and who had never bled were included and randomly y assigned to receive either 5MI (group I,n23) or placebo (group P,n19). Patients with hepatocarcinomas or complications potentially lethal in the short-term or who were being given drugs such as steroids or interferon were excluded. The end points of the study were bleeding and death. There were no significant differences between the groups in the basal clinical and laboratory data. The mean +/- SD follow-up time was 49 +/- 36 and 43 +/- 25 weeks in the groups I and P, respectively. The percentage of patients free of bleeding 61 weeks after inclusion in the study was 62.4% in the group I and 46.3% in the group P (NS). The percentage of patients surviving 85 weeks after inclusion in the study was 81.2% in the group I and 39.8% in the group P (NS). Treatment did not have to be stopped in any patient of both groups because of side effects. In conclusion, 5MI is a safe drug for the chronic management of portal hypertension, that showed a trend to reduce the risk of bleeding and death in cirrhosis with large esophageal varices.(ABSTRACT TRUNCATED AT 250 WORDS)

5 mononitrato de isosorbide en la prevención de la hemorragia digestiva en cirrosis: estudio randomizado. / [Isosorbide-5-mononitrate in the prevention of digestive hemorrhage in cirrhosis: randomized study]

Isosorbide 5-mononitrate (5MI) is a preferential venous dilator that has been shown to decrease portal pressure in acute and long-term haemodynamic studies, and this is not associated with adverse effects on hepatic perfusion. The aim of this trial was to investigate the efficacy and safety of 5MI in the prevention of upper gastrointestinal bleeding in cirrhotic patients. Forty two cirrhotic patients with F2 or F3 esophageal varices showing [quot ]red signs[quot ] and who had never bled were included and randomly y assigned to receive either 5MI (group I,n23) or placebo (group P,n19). Patients with hepatocarcinomas or complications potentially lethal in the short-term or who were being given drugs such as steroids or interferon were excluded. The end points of the study were bleeding and death. There were no significant differences between the groups in the basal clinical and laboratory data. The mean +/- SD follow-up time was 49 +/- 36 and 43 +/- 25 weeks in the groups I and P, respectively. The percentage of patients free of bleeding 61 weeks after inclusion in the study was 62.4

in the group I and 46.3

in the group P (NS). The percentage of patients surviving 85 weeks after inclusion in the study was 81.2

in the group I and 39.8

in the group P (NS). Treatment did not have to be stopped in any patient of both groups because of side effects. In conclusion, 5MI is a safe drug for the chronic management of portal hypertension, that showed a trend to reduce the risk of bleeding and death in cirrhosis with large esophageal varices.(ABSTRACT TRUNCATED AT 250 WORDS)

5 mononitrato de isosorbide en la prevención de la hemorragia digestiva en cirrosis: estudio randomizado / Isosorbide-5-mononitrate in prevention of digestive hemorrhage in cirrhosis: randomized study

El (5MI) es un dilatador venoso preferencial del que se ha mostrado que disminuye la presión venosa portal, en estudios hemodinámicos a corto y largo plazo, y ésto no está asociado con efectos adversos sobre la perfusión hepática. El objetivo de este ensayo fué investigar la eficacia y seguridad del 5MI en la prevención de la hemorragia gastrointestinal alta, en pacientes cirróticos. Cuarenta y dos pacientes cirróticos con várices esofágicas F2 y F3 con "signos rojos", que nunca habian sangrado fueron incluidos y asignados al azar para recibir sea 5Ml (grupo I, n23), o placebo (grupo P, n19). Fueron excluidos los pacientes con hepatocarcinoma o complicaciones potencialmente letales en el corto plazo, o que estuvieran recibiendo drogas tales como esteroides o interfern. Los puntos finales de este estudio fueron hemorragia y muerte. No había diferencias significativas entre los grupos en lo concerniente a datos bajales de clínica y laboratorio. El tiempo medio ñ SD de seguimiento fue de 49 ñ 36 y 43 ñ 25 semanas respectivamente, en los grupos I y P. El porciento de pacientes libres de hemorragia 61 semanas después de la inclusión en el estudio fue 62,4 por ciento en el grupo I y 46,3 por ciento en el grupo P(NS). El porciento de pacientes que sobrevivian 85 semanas después de la inclusión fue 85,2 por ciento en el grupo I y 39,8 por ciento en el grupo P(MS). No hubo que suspender el tratamiento en ningún paciente por efectos colaterales. En conclusión, el 5MI es una droga segura para el tratamiento crónico de la hipertensión portal, que muestra tendencia a reducir el riesgo de sangrado y muerte en cirrosis con várices esofágicas grandes. Merece continuar siendo investigado en estudios controlados (AU)

5 mononitrato de isosorbide en la prevención de la hemorragia digestiva en cirrosis: estudio randomizado / Isosorbide-5-mononitrate in prevention of digestive hemorrhage in cirrhosis: randomized study

El (5MI) es un dilatador venoso preferencial del que se ha mostrado que disminuye la presión venosa portal, en estudios hemodinámicos a corto y largo plazo, y ésto no está asociado con efectos adversos sobre la perfusión hepática. El objetivo de este ensayo fué investigar la eficacia y seguridad del 5MI en la prevención de la hemorragia gastrointestinal alta, en pacientes cirróticos. Cuarenta y dos pacientes cirróticos con várices esofágicas F2 y F3 con "signos rojos", que nunca habian sangrado fueron incluidos y asignados al azar para recibir sea 5Ml (grupo I, n23), o placebo (grupo P, n19). Fueron excluidos los pacientes con hepatocarcinoma o complicaciones potencialmente letales en el corto plazo, o que estuvieran recibiendo drogas tales como esteroides o interfern. Los puntos finales de este estudio fueron hemorragia y muerte. No había diferencias significativas entre los grupos en lo concerniente a datos bajales de clínica y laboratorio. El tiempo medio ñ SD de seguimiento fue de 49 ñ 36 y 43 ñ 25 semanas respectivamente, en los grupos I y P. El porciento de pacientes libres de hemorragia 61 semanas después de la inclusión en el estudio fue 62,4 por ciento en el grupo I y 46,3 por ciento en el grupo P(NS). El porciento de pacientes que sobrevivian 85 semanas después de la inclusión fue 85,2 por ciento en el grupo I y 39,8 por ciento en el grupo P(MS). No hubo que suspender el tratamiento en ningún paciente por efectos colaterales. En conclusión, el 5MI es una droga segura para el tratamiento crónico de la hipertensión portal, que muestra tendencia a reducir el riesgo de sangrado y muerte en cirrosis con várices esofágicas grandes. Merece continuar siendo investigado en estudios controlados

[Upper digestive hemorrhage in liver cirrhosis: clinical and endoscopic findings]. / Hemorragia digestiva alta en la cirrosis hepática: hallazgos clínicos y endoscópicos.

There are different opinions in respect to the main sources in upper gastrointestinal bleeding in hepatic cirrhosis. Some authors claim that ruptured esophageal varices are the cause of most of the hemorrhages. Recently, characteristic lesions have been showed in the gastric mucosa in portal hypertension (congestive gastropathy), and many believe that they are frequently the origin of the bleeding. We reviewed the records of 195 episodes of upper gastrointestinal bleeding in cirrhosis, with endoscopy performed within 12 hours of entry, and report here the endoscopic findings and the bleeding sites. We also investigated the relation between the etiology and functional class of the hepatic disease and the bleeding source. We observed variceal hemorrhage in 52.2% of cases; by gastroduodenal mucosal lesions in 13.8%; by gastric and duodenal ulcers in 13.8%; undetermined origin in 14.8% (due to coexistence of two or more lesions, without active bleeding). We found no differences between alcoholic and nonalcoholic cirrhotics in the bleeding sources. Furthermore, the bleeding sites were not different either in child A, B and C patients. In contrast, in major hemorrhages, esophageal varices were more frequently the origin (73.5%) than in minor ones (40.4%) (p < 0.002). The mortality was significantly higher in CHild C group (25%), than in groups B (14.3%) and A (2.3%) (p < 0.05 and p < 0.002, respectively). We recommend to carry out early endoscopy in every cirrhotic patient suffering from gastrointestinal bleeding, by skilled performers who are able to recognize the gastric red signs, before making a decision about potentially dangerous therapeutic measures, such as surgery, balloon tamponade, etc.

Hemorragia digestiva alta en la cirrosis hepática: hallazgos clínicos y endoscópicos. / [Upper digestive hemorrhage in liver cirrhosis: clinical and endoscopic findings]

There are different opinions in respect to the main sources in upper gastrointestinal bleeding in hepatic cirrhosis. Some authors claim that ruptured esophageal varices are the cause of most of the hemorrhages. Recently, characteristic lesions have been showed in the gastric mucosa in portal hypertension (congestive gastropathy), and many believe that they are frequently the origin of the bleeding. We reviewed the records of 195 episodes of upper gastrointestinal bleeding in cirrhosis, with endoscopy performed within 12 hours of entry, and report here the endoscopic findings and the bleeding sites. We also investigated the relation between the etiology and functional class of the hepatic disease and the bleeding source. We observed variceal hemorrhage in 52.2

of cases; by gastroduodenal mucosal lesions in 13.8

; by gastric and duodenal ulcers in 13.8

; undetermined origin in 14.8

(due to coexistence of two or more lesions, without active bleeding). We found no differences between alcoholic and nonalcoholic cirrhotics in the bleeding sources. Furthermore, the bleeding sites were not different either in child A, B and C patients. In contrast, in major hemorrhages, esophageal varices were more frequently the origin (73.5

) than in minor ones (40.4

) (p < 0.002). The mortality was significantly higher in CHild C group (25

), than in groups B (14.3

) and A (2.3

) (p < 0.05 and p < 0.002, respectively). We recommend to carry out early endoscopy in every cirrhotic patient suffering from gastrointestinal bleeding, by skilled performers who are able to recognize the gastric red signs, before making a decision about potentially dangerous therapeutic measures, such as surgery, balloon tamponade, etc.

Hemorragia digestiva alta en la cirrosis hepática: hallazgos clínicos y endoscópicos. / [Upper digestive hemorrhage in liver cirrhosis: clinical and endoscopic findings]

There are different opinions in respect to the main sources in upper gastrointestinal bleeding in hepatic cirrhosis. Some authors claim that ruptured esophageal varices are the cause of most of the hemorrhages. Recently, characteristic lesions have been showed in the gastric mucosa in portal hypertension (congestive gastropathy), and many believe that they are frequently the origin of the bleeding. We reviewed the records of 195 episodes of upper gastrointestinal bleeding in cirrhosis, with endoscopy performed within 12 hours of entry, and report here the endoscopic findings and the bleeding sites. We also investigated the relation between the etiology and functional class of the hepatic disease and the bleeding source. We observed variceal hemorrhage in 52.2

of cases; by gastroduodenal mucosal lesions in 13.8

; by gastric and duodenal ulcers in 13.8

; undetermined origin in 14.8

(due to coexistence of two or more lesions, without active bleeding). We found no differences between alcoholic and nonalcoholic cirrhotics in the bleeding sources. Furthermore, the bleeding sites were not different either in child A, B and C patients. In contrast, in major hemorrhages, esophageal varices were more frequently the origin (73.5

) than in minor ones (40.4

) (p < 0.002). The mortality was significantly higher in CHild C group (25

), than in groups B (14.3

) and A (2.3

) (p < 0.05 and p < 0.002, respectively). We recommend to carry out early endoscopy in every cirrhotic patient suffering from gastrointestinal bleeding, by skilled performers who are able to recognize the gastric red signs, before making a decision about potentially dangerous therapeutic measures, such as surgery, balloon tamponade, etc.