Background: Acute upper gastrointestinal bleeding in liver cirrhosis combined with acute cerebral infarction is uncommon in clinical work, and then combined with acute myelitis is even rarer and more complex, which po...Background: Acute upper gastrointestinal bleeding in liver cirrhosis combined with acute cerebral infarction is uncommon in clinical work, and then combined with acute myelitis is even rarer and more complex, which poses a greater challenge to clinical diagnosis and treatment. This paper reports a case of acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis, which be hoped to provide a reference for clinical work. Methods: We retrospectively evaluated the clinical information of a 68-year-old female admitted to the Digestive Medical Department with acute gastrointestinal bleeding and appeared limb movement disorder on the third day. Results: The patient was eventually diagnosed with acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis. Conclusions: When patients with liver cirrhosis have abnormal neurological symptoms, in addition to liver cirrhosis-related complications, doctors need to consider cerebrovascular diseases and myelitis.展开更多
Objective: To explore the fatal risk factors of liver cirrhosis complicated with the first upper gastrointestinal bleeding, so as to provide reference for clinical prevention and treatment. Methods: 572 patients with ...Objective: To explore the fatal risk factors of liver cirrhosis complicated with the first upper gastrointestinal bleeding, so as to provide reference for clinical prevention and treatment. Methods: 572 patients with cirrhosis admitted to North China University of Science and Technology and Tangshan Infectious Diseases Hospital from January 2014 to January 2018 were selected. According to whether there is concurrent upper gastrointestinal bleeding, it is divided into 163 cases of hemorrhage group and 409 cases of non-bleeding group. The patients in the hemorrhagic group were divided into case group (65 cases died of first upper gastrointestinal bleeding) and control group (98 cases died of non-first upper gastrointestinal bleeding). The general clinical data, laboratory and imaging data of the patients were analyzed. The risk factors of upper gastrointestinal bleeding in cirrhosis and the independent risk factors of the first upper gastrointestinal bleeding in cirrhosis were analyzed. Results: (1) Univariate analysis showed that: there were significant differences in Hb, PLT, CHE, ALB, TBIL, PT, left gastric vein diameter, portal vein diameter, course of cirrhosis, family history of cirrhosis, Child classification of liver function, esophagogastric varices, ascites, hepatic encephalopathy and portal vein thrombosis between hemorrhagic and non-hemorrhagic groups (P<0.05). The difference was statistically significant;(2) Multivariate logistic regression analysis showed that the diameter of left gastric vein, esophageal varices, ascites, Child C grade of liver function and portal vein thrombosis were risk factors for upper gastrointestinal bleeding in patients with cirrhosis. Left gastric vein diameter, esophagogastric varices and portal vein thrombosis are independent risk factors for first upper gastrointestinal bleeding in cirrhosis. Conclusion:Wider internal diameter of left gastric vein, severe esophagogastric varices and portal vein thrombosis are independent risk factors for fatal upper gastrointestinal bleeding in cirrhosis.展开更多
AIM: To describe the prevalence, diagnosis, treatment, and outcomes of end stage liver disease (ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage (UGIH).
AIM:To determine if proton pump inhibitor use in cirrhotic patients with endoscopic findings of portal hypertension is associated with a lower frequency of gastrointestinal bleeding.METHODS:Patients with cirrhosis and...AIM:To determine if proton pump inhibitor use in cirrhotic patients with endoscopic findings of portal hypertension is associated with a lower frequency of gastrointestinal bleeding.METHODS:Patients with cirrhosis and endoscopic findings related to portal hypertension,receiving or not receiving proton pump inhibitor (PPI) therapy,were included retrospectively.We assigned patients to two groups:group 1 patients underwent PPI therapy and group 2 patients did not undergo PPI therapy.RESULTS:One hundred and five patients with a median age of 58 (26-87) years were included,57 (54.3%) of which were women.Esophageal varices were found in 82 (78%) patients,portal hypertensive gastropathy in 72 (68.6%) patients,and gastric varices in 15 (14.3%) patients.PPI therapy was used in 45.5% of patients (n=48).Seventeen (16.1%) patients presented with upper gastrointestinal bleeding;in 14/17 (82.3%) patients,bleeding was secondary to esophageal varices,and in 3/17 patients bleeding was attributed to portal hypertensive gastropathy.Bleeding related to portal hypertension according to PPI therapy occurred in 18.7% (n=9) of group 1 and in 14% (n=8) of group 2 (odds ratio:0.83,95% confidence interval:0.5-1.3,P=0.51).CONCLUSION:Portal hypertension bleeding is not associated with PPI use.These findings do not support the prescription of PPIs in patients with chronic liver disease with no currently accepted indication.展开更多
BACKGROUND Liver cirrhosis(LC)is a prevalent and severe disease in China.The burden of LC is changing with widespread vaccination of hepatitis B virus(HBV)and antiviral therapy.However,the recent transition in etiolog...BACKGROUND Liver cirrhosis(LC)is a prevalent and severe disease in China.The burden of LC is changing with widespread vaccination of hepatitis B virus(HBV)and antiviral therapy.However,the recent transition in etiologies and clinical features of LC cases requiring hospitalization is unclear.AIM To identify the transition in etiologies and clinical characteristics of hospitalized LC patients in Southern China.METHODS In this retrospective,cross-sectional study we included LC inpatients admitted between January 2001 and December 2020.Medical data indicating etiological diagnosis and LC complications,and demographic,laboratory,and imaging data were collected from our hospital-based dataset.The etiologies of LC were mainly determined according to the discharge diagnosis,and upper gastrointestinal bleeding,ascites,hepatic encephalopathy,spontaneous bacterial peritonitis,hepatocellular carcinoma(HCC),portal vein thrombosis,hepatorenal syndrome,and acute-on-chronic liver failure(ACLF)were considered LC-related complications in our study.Changing trends in the etiologies and clinical characteristics were investigated using logistic regression,and temporal trends in proportions of separated years were investigated using the Cochran-Armitage test.In-hospital prognosis and risk factors associated with in-hospital mortality were also invest igated.RESULTS A total of 33143 patients were included in the study[mean(SD)age,51.7(11.9)years],and 82.2%were males.The mean age of the study population increased from 51.0 years in 2001-2010 to 52.0 years in 2011-2020(P<0.001),and the proportion of female patients increased from 16.7%in 2001-2010 to 18.2%in 2011-2020(P=0.003).LC patients in the decompensated stage at diagnosis decreased from 68.1%in 2001-2010 to 64.6%in 2011-2020(P<0.001),and the median score of model for end-stage liver disease also decreased from 14.0 to 11.0(P<0.001).HBV remained the major etiology of LC(75.0%)and the dominant cause of viral hepatitis-LC(94.5%)during the study period.However,the proportion of HBV-LC decreased from 82.4%in 2001-2005 to 74.2%in 2016-2020,and the proportion of viral hepatitis-LC decreased from 85.2%in 2001-2005 to 78.1%in 2016-2020(both P for trend<0.001).Meanwhile,the proportions of LC caused by alcoholic liver disease,autoimmune hepatitis and mixed etiology increased by 2.5%,0.8%and 4.5%,respectively(all P for trend<0.001).In-hospital mortality was stable at 1.0%in 2011-2020,whereas HCC and ACLF manifested the highest increases in prevalence among all LC complications(35.8%to 41.0%and 5.7%to 12.4%,respectively)and were associated with 6-fold and 4-fold increased risks of mortality(odds ratios:6.03 and 4.22,respectively).CONCLUSION LC inpatients have experienced changes in age distribution and etiologies of cirrhosis over the last 20 years in Southern China.HCC and ACLF are associated with the highest risk of in-hospital mortality among LC complications.展开更多
文摘Background: Acute upper gastrointestinal bleeding in liver cirrhosis combined with acute cerebral infarction is uncommon in clinical work, and then combined with acute myelitis is even rarer and more complex, which poses a greater challenge to clinical diagnosis and treatment. This paper reports a case of acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis, which be hoped to provide a reference for clinical work. Methods: We retrospectively evaluated the clinical information of a 68-year-old female admitted to the Digestive Medical Department with acute gastrointestinal bleeding and appeared limb movement disorder on the third day. Results: The patient was eventually diagnosed with acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis. Conclusions: When patients with liver cirrhosis have abnormal neurological symptoms, in addition to liver cirrhosis-related complications, doctors need to consider cerebrovascular diseases and myelitis.
文摘Objective: To explore the fatal risk factors of liver cirrhosis complicated with the first upper gastrointestinal bleeding, so as to provide reference for clinical prevention and treatment. Methods: 572 patients with cirrhosis admitted to North China University of Science and Technology and Tangshan Infectious Diseases Hospital from January 2014 to January 2018 were selected. According to whether there is concurrent upper gastrointestinal bleeding, it is divided into 163 cases of hemorrhage group and 409 cases of non-bleeding group. The patients in the hemorrhagic group were divided into case group (65 cases died of first upper gastrointestinal bleeding) and control group (98 cases died of non-first upper gastrointestinal bleeding). The general clinical data, laboratory and imaging data of the patients were analyzed. The risk factors of upper gastrointestinal bleeding in cirrhosis and the independent risk factors of the first upper gastrointestinal bleeding in cirrhosis were analyzed. Results: (1) Univariate analysis showed that: there were significant differences in Hb, PLT, CHE, ALB, TBIL, PT, left gastric vein diameter, portal vein diameter, course of cirrhosis, family history of cirrhosis, Child classification of liver function, esophagogastric varices, ascites, hepatic encephalopathy and portal vein thrombosis between hemorrhagic and non-hemorrhagic groups (P<0.05). The difference was statistically significant;(2) Multivariate logistic regression analysis showed that the diameter of left gastric vein, esophageal varices, ascites, Child C grade of liver function and portal vein thrombosis were risk factors for upper gastrointestinal bleeding in patients with cirrhosis. Left gastric vein diameter, esophagogastric varices and portal vein thrombosis are independent risk factors for first upper gastrointestinal bleeding in cirrhosis. Conclusion:Wider internal diameter of left gastric vein, severe esophagogastric varices and portal vein thrombosis are independent risk factors for fatal upper gastrointestinal bleeding in cirrhosis.
基金Supported by National Institutes of Health,No.41301Veteran Administration Clinical Merit Review Grant,to Dr Dennis M JensenPhilippe Foundation Grant,to Dr.Marine Camus
文摘AIM: To describe the prevalence, diagnosis, treatment, and outcomes of end stage liver disease (ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage (UGIH).
文摘AIM:To determine if proton pump inhibitor use in cirrhotic patients with endoscopic findings of portal hypertension is associated with a lower frequency of gastrointestinal bleeding.METHODS:Patients with cirrhosis and endoscopic findings related to portal hypertension,receiving or not receiving proton pump inhibitor (PPI) therapy,were included retrospectively.We assigned patients to two groups:group 1 patients underwent PPI therapy and group 2 patients did not undergo PPI therapy.RESULTS:One hundred and five patients with a median age of 58 (26-87) years were included,57 (54.3%) of which were women.Esophageal varices were found in 82 (78%) patients,portal hypertensive gastropathy in 72 (68.6%) patients,and gastric varices in 15 (14.3%) patients.PPI therapy was used in 45.5% of patients (n=48).Seventeen (16.1%) patients presented with upper gastrointestinal bleeding;in 14/17 (82.3%) patients,bleeding was secondary to esophageal varices,and in 3/17 patients bleeding was attributed to portal hypertensive gastropathy.Bleeding related to portal hypertension according to PPI therapy occurred in 18.7% (n=9) of group 1 and in 14% (n=8) of group 2 (odds ratio:0.83,95% confidence interval:0.5-1.3,P=0.51).CONCLUSION:Portal hypertension bleeding is not associated with PPI use.These findings do not support the prescription of PPIs in patients with chronic liver disease with no currently accepted indication.
基金Supported by National Natural Science Foundation of China,No.82070574Natural Science Foundation of Guangdong Province Team Project,No.2018B030312009.
文摘BACKGROUND Liver cirrhosis(LC)is a prevalent and severe disease in China.The burden of LC is changing with widespread vaccination of hepatitis B virus(HBV)and antiviral therapy.However,the recent transition in etiologies and clinical features of LC cases requiring hospitalization is unclear.AIM To identify the transition in etiologies and clinical characteristics of hospitalized LC patients in Southern China.METHODS In this retrospective,cross-sectional study we included LC inpatients admitted between January 2001 and December 2020.Medical data indicating etiological diagnosis and LC complications,and demographic,laboratory,and imaging data were collected from our hospital-based dataset.The etiologies of LC were mainly determined according to the discharge diagnosis,and upper gastrointestinal bleeding,ascites,hepatic encephalopathy,spontaneous bacterial peritonitis,hepatocellular carcinoma(HCC),portal vein thrombosis,hepatorenal syndrome,and acute-on-chronic liver failure(ACLF)were considered LC-related complications in our study.Changing trends in the etiologies and clinical characteristics were investigated using logistic regression,and temporal trends in proportions of separated years were investigated using the Cochran-Armitage test.In-hospital prognosis and risk factors associated with in-hospital mortality were also invest igated.RESULTS A total of 33143 patients were included in the study[mean(SD)age,51.7(11.9)years],and 82.2%were males.The mean age of the study population increased from 51.0 years in 2001-2010 to 52.0 years in 2011-2020(P<0.001),and the proportion of female patients increased from 16.7%in 2001-2010 to 18.2%in 2011-2020(P=0.003).LC patients in the decompensated stage at diagnosis decreased from 68.1%in 2001-2010 to 64.6%in 2011-2020(P<0.001),and the median score of model for end-stage liver disease also decreased from 14.0 to 11.0(P<0.001).HBV remained the major etiology of LC(75.0%)and the dominant cause of viral hepatitis-LC(94.5%)during the study period.However,the proportion of HBV-LC decreased from 82.4%in 2001-2005 to 74.2%in 2016-2020,and the proportion of viral hepatitis-LC decreased from 85.2%in 2001-2005 to 78.1%in 2016-2020(both P for trend<0.001).Meanwhile,the proportions of LC caused by alcoholic liver disease,autoimmune hepatitis and mixed etiology increased by 2.5%,0.8%and 4.5%,respectively(all P for trend<0.001).In-hospital mortality was stable at 1.0%in 2011-2020,whereas HCC and ACLF manifested the highest increases in prevalence among all LC complications(35.8%to 41.0%and 5.7%to 12.4%,respectively)and were associated with 6-fold and 4-fold increased risks of mortality(odds ratios:6.03 and 4.22,respectively).CONCLUSION LC inpatients have experienced changes in age distribution and etiologies of cirrhosis over the last 20 years in Southern China.HCC and ACLF are associated with the highest risk of in-hospital mortality among LC complications.
