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Title: Gastric Variceal Bleeding In Patients of Liver Cirrhosis With Portal Hypertension
Authors: Muhammad Fahad Zakir, Adeel Afzal, Hamid Ali Kalwar, Ghulam Mujtaba, Shahid Karim, Manzoor Hussain
Journal: Pakistan Armed Forces Medical Journal (PAFMJ)
Publisher: Army Medical College, Rawalpindi.
Country: Pakistan
Year: 2024
Volume: 74
Issue: 3
Language: English
Keywords: Chronic liver diseaseCirrhosisEsophageal varicesGastric varicealPortal hypertension.
Objective: to establish how common Gastric Variceal bleeding is in Chronic liver Disease patients to allow them to be screened regularly and avoid morbidity and mortality.
Study Design: Cross sectional study.
Place and Duration of Study: Gastroenterology Department, Liaquat National Hospital and Medical College, Karachi Pakistan, from Jan to Dec 2020.
Methodology: A total of 135 patients with history of melena, hematemesis and known diagnosis of Chronic liver Disease for more than six months who fulfilled the inclusion criteria were enrolled in this study. Gastroscopy was carried out and dilated veins in the gastric fundus, either with active spurter or an overlying punctum, were labelled as Gastric Variceal bleeding.
Results: This study included known Chronic Liver Disease patients for duration of 6 months or more with recent stigmata of upper Gastrointestinal Bleed. Out of 135 cases, 76(56.3%) were male and 59(43.7%) were female. Enrolled patients’ mean age was 51.0±5.2 years, and the mean duration of Chronic liver Disease was 4.9±2.6 years. Gastric Variceal bleeding in Chronic liver Disease patients who underwent endoscopy had a frequency of 18(13.3%) times.
Conclusion: Gastric Variceal bleeding bleeding is rare but lethal complication of Chronic liver Disease, seen in patients in the age group of <50 years, female gender, hypertensive patients, and those with a duration of chronic liver disease <5 years.
To establish the prevalence of Gastric Variceal bleeding in Chronic Liver Disease patients to facilitate regular screening and reduce morbidity and mortality.
A cross-sectional study was conducted at the Gastroenterology Department of Liaquat National Hospital, Karachi, Pakistan, from January to December 2020. A total of 135 patients with a history of melena or hematemesis and a diagnosis of Chronic Liver Disease for over six months, meeting specific inclusion criteria (including age 40-60, hematology, and ultrasound findings), were enrolled. Gastroscopy was performed to identify Gastric Variceal bleeding, defined as dilated veins in the gastric fundus with active bleeding or an overlying punctum. Statistical analysis was performed using SPSS version 21.0, with frequencies, percentages, mean±standard deviation, and Chi-square tests.
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C --> D["Identify Gastric Variceal Bleeding"];
D -- Yes --> E["Record Data"];
D -- No --> E;
E --> F["Data Analysis SPSS v21.0"];
F --> G["Statistical Tests Chi-square"];
G --> H["Interpret Results"];
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Gastric varices are a less common but potentially lethal complication of portal hypertension in patients with chronic liver disease. While bleeding from gastric varices is less frequent than from esophageal varices, it can be more severe. The study's findings on the prevalence of gastric variceal bleeding (13.3%) are discussed in the context of existing literature, with potential explanations for regional variations including the higher seroprevalence of viral hepatitis in Pakistan. The importance of endoscopy as a diagnostic and therapeutic tool is highlighted.
Out of 135 patients, 18 (13.3%) had Gastric Variceal bleeding. The mean age was 51.0±5.2 years, and the mean duration of Chronic Liver Disease was 4.9±2.6 years. There was a higher proportion of males (56.3%) than females (43.7%). The study found no significant difference in the rate of gastric variceal bleeding between males and females, or across different durations of chronic liver disease. Similarly, no significant association was found between gastric variceal bleeding and hypertension, diabetes mellitus, or ischemic heart disease.
Gastric variceal bleeding is an uncommon but lethal complication of chronic liver disease. The study suggests it is seen in patients younger than 50 years, females, hypertensive patients, and those with a chronic liver disease duration of less than 5 years. Acute hemorrhage from gastric variceal bleeding requires a multidisciplinary team approach for effective management.
1. Prevalence of Gastric Variceal Bleeding: The study reported a frequency of 18 (13.3%) cases of Gastric Variceal bleeding out of 135 enrolled patients.
2. Gender Distribution: Out of 135 cases, 76 (56.3%) were male and 59 (43.7%) were female.
3. Mean Age: The mean age of the enrolled patients was 51.0±5.2 years.
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