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Survival of patients with cirrhosis and acute peptic ulcer bleeding compared with variceal bleeding using current first‐line therapies
Author(s) -
Ardevol Alba,
IbañezSanz Gemma,
Profitos Joaquim,
Aracil Carles,
Castellvi Josep M.,
Alvarado Edilmar,
Cachero Alba,
Horta Diana,
Miñana Josep,
GomezPastrana Bárbara,
Pavel Oana,
Dueñas Eva,
Casas Meritxell,
Planella Montserrat,
Castellote Jose,
Villanueva Candid
Publication year - 2018
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.29370
Subject(s) - medicine , cirrhosis , gastroenterology , gastrointestinal bleeding , portal hypertension , upper gastrointestinal bleeding , odds ratio , proton pump inhibitor , model for end stage liver disease , surgery , endoscopy , liver transplantation , transplantation
The presence of cirrhosis increases the mortality of patients with peptic ulcer bleeding (PUB). Both acute variceal bleeding (AVB) and PUB are associated with substantial mortality in cirrhosis. This multicenter cohort study was performed to assess whether the mortality of patients with cirrhosis with PUB is different from that of those with AVB. Patients with cirrhosis and acute gastrointestinal bleeding were consecutively included and treated with somatostatin and proton pump inhibitor infusion from admission and with antibiotic prophylaxis. Emergency endoscopy with endoscopic therapy was performed within the first 6 hours. 646 patients with AVB and 144 with PUB were included. There were baseline differences between groups, such as use of gastroerosive drugs or β‐blockers. Child‐Pugh and Model for End‐Stage Liver Disease MELD scores were similar. Further bleeding was more frequent in the AVB group than those in the PUB group (18% vs. 10%; odds ratio [OR] = 0.50; 95% confidence interval [CI] = 0.29‐0.88). However, mortality risk at 45 days was similar in both groups (19% in the AVB group vs. 17% in the PUB group; OR = 0.85; 95% CI = 0.55‐1.33; P = 0.48). Different parameters, such as Child‐Pugh score, acute kidney injury, acute on chronic liver failure, or presence of shock or bacterial infection, but not the cause of bleeding, were related to the risk of death. Only 2% of the PUB group versus 3% of the AVB group died with uncontrolled bleeding ( P = 0.39), whereas the majority of patients in either group died from liver failure or attributed to other comorbidities. Conclusion: Using current first‐line therapy, patients with cirrhosis and acute peptic ulcer bleeding have a similar survival than those with variceal bleeding. The risk of further bleeding is higher in patients with variceal hemorrhage. However, few patients in both groups died from uncontrolled bleeding, rather the cause of death was usually related to liver failure or comorbidities. (H epatology 2018;67:1458‐1471).