Acute Variceal Bleeding in Patients with Liver Cirrhosis with and without Diabetes
DOI:
https://doi.org/10.17140/lroj-1-103Keywords:
Diabetes, Esophageal varices, Liver cirrhosisAbstract
Objectives: To study the effect of diabetes mellitus on presentations, course, and outcome of acute variceal bleeding in cirrhotic patients.
Methods: We compared 2 matched groups of patients, a diabetic group and non-diabetic group, where all of the patients presented with acute esophageal varices due to liver cirrhosis. All patients underwent history taking, clinical examination, emergency treatment, upper endoscopy, laboratory investigations and abdominal ultrasound; they followed up until hospital discharge.
Results: The diabetic group showed statistically significant unstable course in 73.3% of them compared to 36.6% in the control; more attacks of melena (2.2±1.03) compared to control (1.7±0.88), and also had significantly disturbed level of consciousness compared to control (36.7% versus 10% respectively); moreover they have significantly more right and left lobe enlargement than control (70% versus 26.7%, and 66.7 versus 40% respectively), significantly more echogenic liver (70% versus 33.3), highly significant more portal vein dilatations (73.3% versus 16.7%) and highly significant more collaterals (50% versus 23.3%); the splenic size was also significantly more enlarged in diabetics (60%) than control (40%), and the splenic vein diameter was significantly more dilated in diabetics (33.3%) versus control group (6.7%); finally the mortality was more in the diabetic group.
Conclusions: Diabetic patients with acute variceal bleeding may show more morbidity and mortality rates.
References
Tripathi D, Ferguson JW, Kochar N, et al. Randomized con-trolled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed. Hepatology. 2009; 50: 825-833. doi: 10.1002/hep.23045
Shah HA, Azam Z, Rauf J, et al. Carvedilol vs. esophageal va-riceal band ligation in the primary prophylaxis of variceal hem-orrhage: a multicentre randomized controlled trial. J Hepatol. 2014; 60: 757-764. doi: 10.1016/j.jhep.2013.11.019
Gluud LL, Krag A. Banding ligation versus beta-blockers for primary prevention in oesophagealvarices in adults. Co-chrane Database Syst Rev. 2012; 2012(8): CD004544. doi: 10.1002/14651858.CD004544.pub2
Monescillo A, Martinez-Lagares F, Ruiz-del-Arbol L, et al. Influence of portal hypertension and its early decompression by TIPS Placement on the outcome of variceal bleeding. Hepatol-ogy. 2004; 40: 793-801.
El-Serag HB, Everhart JE. Improved survival after variceal-hemorrhage over an 11-year period in the Department of Vet-erans Affairs. Am J Gastroenterol. 2000; 95: 3566-3573. doi: 10.1111/j.1572-0241.2000.03376.x
McCormick PA, O’Keefe C. Improving prognosis following a first variceal haemorrhage over four decades. Gut. 2001; 49: 607-608. doi: 10.1136/gut.49.5.682
Pagliaro L, D’Amico G, Pasta L, et al. Portal hypertension in cirrhosis: Natural history. In: Bosch J, Groszmann RJ. eds. Portal Hypertension. Pathophysiology and Treatment. Oxford: Blackwell Scientific, 1994: 72-92.
Imano E, Kanda T, Nakatani Y, et al. Impaired splanchnic and Peripheral glucose uptake in liver cirrhosis. J Hepatol. 1999; 31: 469-473. doi: 10.1016/S0168-8278(99)80039-7
Bianchi G, Marchesini G, Zoli M, Bugianesi E, Fabbri A, Pisi E. Prognostic significance of diabetes in patients with cirrho-sis. Hepatology. 1994; 20: 119-125. doi: 10.1016/S0168-8278- (99)80039-7
Moreau R, Chagneau C, Heller J, et al. Hemodynamic, meta-bolicand hormonal responses to oral glibenclamide in patients with cirrhosis receiving glucose. Scand J Gastroenterol. 2001; 36: 303-308.
Paquet KJ. Causes and pathomechanisms of esophageal va-rices development. Med Sci Monit. 2000; 6: 915-928.
Sarin SK, Kumar A. Gastric varices: profil, classification, and management. Am J Gastroenterol. 1989; 84: 1244-1249.
De Franchis R. Updating consensus in portal hypertension: report of the Baveno III Cpnsensus Workshop on definitions, methodology and therapeutic strategies in portal hyperten-sion. J Hepatol. 2000; 33: 846-852. doi: 10.1016/S0168-8278- (00)80320-7
Mohamoud YA, Mumtaz GR, Riome S, Miller DW, Abu-Radda LJ. The epidemiology of hepatitis C virus in Egypt: a systematic review and data synthesis. BMC Infectious Diseases. 2013; 13: 288. doi: 10.1186/1471-2334-13-288
Pugliese D, Lee SS, Koshy A, Cerini R, Ozier Y, Lebrec D. Systemic and splanchnic hemodynamic effects of intravenous hypertonic glucose in patients with cirrhosis. Hepatology. 1988; 8(3): 643-646. doi: 10.1002/hep.1840080334
Lee J-Y, Huo T-I, Wang S-S, et al. Diabetes diminishes the portal-systemic collateral vascular response to vasopressin via vasopressin receptor and ga proteins regulations in cirrhotic rats. PLoS ONE. 2013; 8(7): e67703. doi: 10.1371/journal. pone.0067703
Majid S, Azam Z, Shah HA, et al. Factors determining the clinical outcome of acute variceal bleed in cirrhotic patients. In-dian J Gastroenterol. 2009; 28(3): 93-95. doi: 10.1007/s12664- 009-0034-z
Loimaala A, Groundstroem K, Rinne M, et al. Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with diabetes mellitus. Am J Cardi-ol. 2009; 103(7): 972-977. doi: 10.1016/j.amjcard.2008.12.026
Jutabha R, Jensen DM. Management of upper gastrointestinal bleeding in the patient with chronic liver disease. Med Clin North Am. 1996; 80: 1035. doi: 10.1016/S0025-7125(05)70479-X
Ahn H-R, Shin M-H, Nam H-S, et al. The association be-tween liver enzymes and risk of type 2 diabetes: the Namwon study. Diabetology & Metabolic Syndrome. 2014; 6: 14. doi: 10.1186/1758-5996-6-14
Scatarige JC, Scott WW, Donovan PJ, Siegelman SS, Sand-ers RC. Fatty infiltration of the liver: ultrasonographic and com-puterized tomographic correlation. J Ultrasound Med. 1984; 3: 9-14.
Silverman JF, O’Brien KF, Long S, et al. Liver pathology in morbidly obese patients with and without diabetes. Am J Gastro-enterol. 1990; 85: 1349-1355.
Khan A, Safdar M, Ali Khan MM, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003; 26(12): 3215-3218. doi: 10.2337/diacare.26.12.3215
Maruyama H, Yokosuka O. Pathophysiology of portal hyper-tension and esophageal varices. International Journal of Hepa-tology. 2012; 2012. doi: 10.1155/2012/895787
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