Vol.13, No 3, 2006 pp. 164 - 167
UC 616.36-004
PREDICTIVE FACTORS OF BLEEDING FROM ESOPHAGEAL VARICES
IN PATIENTS WITH LIVER CIRRHOSIS AND PORTAL HYPERTENSION
Daniela Benedeto-Stojanov1, Aleksandar Nagorni1, Goran Bjelaković1, Jovica Milanović1, Dragan Stojanov2
1Clinic for Gastroenterology and Hepatology, Clinical Center Niš
2Radiology Institute, Clinical Center Niš
 E-mail: stojanovd@ptt.yu
Summary. Variceal bleeding is the most life-threating complication in liver cirrhosis. The aim of this study was to ascertain the risk factors of bleeding from esophageal varices.52 patients with liver cirrhosis and portal hypertension were included in prospective study. We analyzed the severity of liver dysfunction according to Child's classification, coagulation parameters, and endoscopic parameters: size, color, location of varices, and the presence   of "red signs". Varices were classified as small, medium and large.Esophageal varices were found in 76.9% of the patients with liver cirrhosis and portal hypertension. Small varices were present in 10%, medium in 25% and large in 65% patients.  55% of them had variceal bleeding. Variceal bleeding was present in 50% patients with medium and in 65.38% patients with large varices. There was no bleeding in patients with small varices.Endoscopy revealed "red signs" before bleeding in 85% patients with large varices. There was a higher incidence of variceal bleeding in Child's group B. There were no significant differences (p>0.05) of the coagulation parameters in patients with and without variceal bleeding. Rebleeding was present in 86.36% patients. Most of them (52.63%) rebled between 7 weeks and 12 months after the first episode of variceal bleeding. In the patients with the most severe hepatocellular dysfunction (Child's group C) period between the first bleeding and rebleeding was the shortest (mean 20.8 days). Our study revealed association between the first bleeding and large varices and the "red signs". Coagulation disorders and hepatic dysfunction were not related to the initial episode of variceal bleeding. The risk of early rebleeding was higher in patients with severe hepatic dysfunction (Child's class C).
Key words: Risk factors, variceal bleeding, esophageal varices, portal hypertension, cirrhosis hepatis
PREDIKTIVNI FAKTORI KRVARENJA IZ EZOFAGEALNIH VARICESA
U BOLESNIKA SA CIROZOM JETRE I PORTNOM HIPERTENZIJOM
Kratak sadržaj: Krvarenje iz varikoziteta je najteža komplikacija ciroze jetre. Cilj naše studije je procena faktora rizika za krvarenje iz ezofagogastričnih varikoziteta. Prospektivnom studijom obuhvaćeno je 52 bolesnika sa  cirozom jetre i portnom hipertenzijom. Analizirna je težina insuficijencije jetre po Child klasifikaciji, koagulacioni parameteri i endoskopski parameti: veličina, boja i lokalizacija varikoziteta i prisustvo "red signs". Po veličini varikoziteti su klasifikovani kao mali, srednji i veliki. Ezofagealni varikoziteti su dijagnostikovani u 76.9% bolesnika sa cirozom jetre i portnom hipertenzijom. Mali variksi su bili prisutni u 10%, srednji u 25% i veliki u 65% bolesnika.  Varikozno krvarenje je nadjeno u 55% bolesnika. Varikozno krvarenje je bilo prisutno u 50% bolesnika sa srednjim i u 65.38% bolesnika sa velikim variksima. Bolesnici sa malim variksima nisu krvarili. U 85% bolesnika sa velikim varikozitetima endoskopija je pokazala "red signs". Nadjena je veća incidenca varikoznog krvarenja u B grupi po Child-u.  Nije bilo signifikantne razlike (p>0,05)  koagulacionih parametara u bolesnika sa i bez varikoznog kvarenja. Rekrvarenje se javilo u 86,36% bolesnika. Većina (52,63%) je imalo rekrvarenje izmedju sedme nedelje i 12 meseci posle inicijalnog krvarenja. Period izmedju prvog krvarenja i rekrvarenja je bio najkraći (20,8 dana) u bolesnika sa najtežim stepenom insuficijencije jetre (Child C). Naša studija je pokazala da je varikozno krvarenje u vezi sa velikim variksima i prisustvom "red signs". Koagulacioni poremećaji i hepatična disfunkcija nisu bili u vezi sa inicijalnom epizodom varicealnog krvarenja. Rizik ranog rekrvarenja je bio veći u pacijenata sa teškom insuficijencijom jetre (Child C).
Ključne reči: faktori rizika, varicealno krvarenje, ezofagealni varicesi, portna hipertenzija, ciroza jetre