Clinical Features Analysis Of Cirrhotic Patients With First Upper Gastrointestinal Bleeding

Objective: To analyse the clinical features of cirrhotic patients with first upper gastrointestinal bleeding(UGIB),and to provide reference for the clinical evaluation of the causes of bleeding,prognosis of bleeding and the timeyl and exact treatment.Methods: The records of 128 cirrhotic patients with first UGIB in The Second affiliated Hospital of Dalian Medical University from January 2012 to December 2016 are reviewed retrospectively in this study.Result:(1)The male and female account for about 71.88% and 28.12% of 128 cases respectively,so the ratio of male and female is 2.6:1.The average age of this sample is60.83±11.75 years old,and the high incidence be in 50-74 years old,with percentage of63.28%.The peaking-age is 54-64 years old.(2)25% of the patients have inducements such as hard and stimulating food,NSAIDs,emotion factors and bowel movement.75% of patients have no inducements.There is no statistical significance between esophagogastric variceal bleeding(EVB)group and nonvariceal upper gastrointestinal bleeding(NVUGIB)group for bleeding inducements.(3)The reason for upper gastrointestinal bleeding of cirrhosis can be divided into two parts,and they are esophagogastric variceal bleeding and nonvariceal upper gastrointestinal bleeding,which account for 76.56% and 23.44% respectively.Peptic ulcer(PU),portal hypertensive gastropathy(PHG)are the main diseases in the NVUGIB group and they make up about 43.33%,23.33% of NVUGIB respectively.(4)According to this study,UGIB is the starting-symptom of liver cirrhosis for more than 53.91% of patients.The peak stage from the diagnosis of liver cirrhosis to the firstupper gastrointestinal bleeding is 1-3years,with the ratio of 32.20%.(5)In this study,viral hepatitis and alcohol liver disease are the main etiologies of liver cirrhosis,and they respectively account for 44.53%,21.88%.The ratio of hepatitis B and hepatitis C is 10.4:1.(6)The characteristics of UGIB shows that vomiting blood is the main manifestation for EVB group,and black bowels is the main manifestation for NVUGIB group.EVB prones to hemorrhagic shock.There is no clear correlation between the bleeding volume and Child-pugh classification in EVB group.(7)Other complications include infection,hepatic encephalopathy,hepatorenal syndrome,with incidence of 14.84%,11.72% and 0.78% respectively,and the differences in incidence of complications between EVB group and NVUGIB group have no statistical significance.2 patients died of uncontrolled hemorrhagic shock in EVB group,and the total mortality is 1.56%.There is no statistical significance between two groups for the difference of mortality.Conclusion: 1.The male is more than female for patients of liver cirrhosis combined with first upper gastrointestinal bleeding.The average age of this sample is 60.83±11.75 years old,and the high incidence be in 50-74 years old.Some patients have a clear inducement of bleeding,but a majority of patients with upper gastrointestinal bleeding has no inducements.2.The peak stage from the diagnosis of liver cirrhosis to the first upper gastrointestinal bleeding is 1-3years.3.The etiology of liver cirrhosis shows that viral hepatitis and alcohol liver disease are the main etiologies of liver cirrhosis.4.The reasons for the first upper gastrointestinal bleeding in patients with cirrhosis are diverse,including esophagogastric variceal bleeding and nonvariceal upper gastrointestinal bleeding,and peptic ulcer and portal hypertensive gastropathy are the main diseases of NVUGIB.The characteristics of UGIB shows that vomiting blood and black bowels are the main manifestations for EVB group and NVUGIB group respectively.There is no correlation between the bleeding volume and Child-pugh classification inEVB group.5.Other complications include infection,hepatic encephalopathy,hepatorenal syndrome,and there is no statistical significance between EVB group and NVUGIB group for these complications.