10Oct 2017

BLEEDING OESOPHAGEAL VARICES, CLINICAL PRESENTATION AND OUTCOME OF MANAGEMENT IN WAD MADANI TEACHING HOSPITAL.

  • MD in General Surgery, 2011, Faculty of Medicine.
Crossref Cited-by Linking logo

  • Abstract
  • References
  • Cite This Article as
  • Corresponding Author

Bleeding oesophageal varices is a common complication of Portal hypertension (PHTN) in Gezira state. The most common cause of PHTN is periportal fibrosis due to Schistosomiasis. The aim of this work is to study the clinical presentation of this life threatening condition and to evaluate the outcome of management. This study is a prospective hospital based clinical study which was carried out in Wad Madani Teaching Hospital (WMTH) during the period from Jan 2009 to Dec 2010. A total of 75 (n=75) patients suffering from bleeding oesophageal varices were included in the study. Any patients from other causes of bleeding were excluded. All patients had a good history, physical examination and investigation for their bleeding episodes. Different metholodgy were used. All patients were followed up during this period for variceal rebleeding. The study included 75 patients: 53 patients (70.7%) were males and 22 patients (29.3%) were females, with a male to female ratio of (2.4:1.0).The past medical history showed 60% of them had schistosomiasis. Patients who presented with haematemesis were 64 patients (85.3%). Splenomegaly was found in 55 patients (73.3%). Pancytopenia was found in 67 patients (89.3%). The study showed that any size of oesophageal varices can bleed regardless of the grading. There was recurrent bleeding in 17 patients (22.7%).Unfortunately five patients died during this study constituting 6.7% mortality. This study concluded that the commonest cause of variceal bleeding is schistosomal portal hypertension. Outcomes are poor once variceal bleeding has occurred, therefore primary prophylaxis is indicated. Because there is a high risk of recurrence after an initial haemorrhage, preventive strategies are required and should be tailored to the patient?s clinical condition, surgical risk and prognosis. With regards to the treatment of acute haemorrhage, treatment with a combination of methods is likely to gain popularity.

  1. Samy A Azer, M. P. Esophageal Varices. Journal article : http://emedicine.medscape.com/article/175248-overview.
  2. Eugene R. Schiff, Michael F. Sorrell, Willis C. Maddrey. Schiff's diseases of the liver. lippincott williams & wilkins. 2006: 443pp
  3. Henryk Dancygier, Scott L. (FRW) Friedman, H. D. (CON) Allescher, U. (CON) Beuers. Clinical Hepatology: Principles and Practice of Hepatobiliary Diseases. springer, 2010. 978pp.
  4. Brocchi E, Caletti G, et al. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med? 1988, 319(15):983-9.
  5. Grege Browne.Treatment of Esophageal Varices. 1996. http://www.med.mun.ca/tedhoekman/surgery/esophval.htm
  6. Lebrec, D. Long-term management of variceal bleeding: The place of pharmacotherapy . World Journal of Surgery , 1994. V 18, No(2): 229-232.
  7. BR, MacDougall; D, Westaby; A, Theodossi; JL, Dawson; R, Williams. Increased long-term survival in variceal haemorrhage using injection sclerotherapy. Results of a controlled trial. Lancet , 1982: 1(8264):124-7.
  8. Robert H. Schapiro.And the bands play on. Journal article. Hepatolgy 1994 feb.19(2):542-543
  9. Ala I. Sharara, and Don C. Rockey. Gastroesophageal Haemorrahge. N Engl J Med 2001; 345:669-681
  10. Sanjo K, Imanishi H et al: The current role of devascularization and transection procedures in portal hypertension. Nippon Geka Gakkai Zasshi. 1992 Sep; 93(9):1164-8.
  11. KM Barber, J. A. Life Expectancy Of Liver Transplant Recipients In The UK. Gut , 2007. 56(2):279-82.
  12. Thomopoulosa, C. L.K Mimidisb, E. C. Non-invasive predictors of the presence of large oesophageal varices in patients with cirrhosis. Dig Liv Dis.35(7):473-8.
  13. Barrera F, R. A.-A. Platelet count/spleen diameter ratio for non-invasive prediction of high risk esophageal varices in cirrhotic patients. Ann Hepatol 2009 Oct;8(4)325-30.
  14. Gerard M. Doherty. CURRENT Diagnosis & Treatment: Surgery 13e, 2010: 325pp.
  15. Beppu K, Koyanagi N.. et al. Prediction of variceal hemorrhage by esophageal endoscopy. Gastrointest Endosc , 1981. 27(4):213-8.
  16. Noninvasive Procedures Show Promise for Esophageal Bleeding. (2008, 5 25). http://www.nlm.nih.gov/medlineplus/ency/article/000268.htm
  17. Shen M, Z. K. Evaluation of esophageal varices and predicting the risk of esophageal varices bleeding with multi-detector CT in patients with portal hypertension. Zhonghua Yi Xue Za Zhi. 2010 Nov. 90(41):2911-5 .
  18. R, d. F., & M, P. Why do varices bleed? Gastroenterol Clin North Am , 2008.21(1):85-101.
  19. Westaby, S. G. Recent advances in the endoscopic management of variceal bleeding. Gut 1992 :36(5)645-8.
  20. Laine L, e.-N. H. Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices. Ann Intern Med 1993 Jul 1;119(1):1-7.
  21. Heresbach D, J. C.. Sclerotherapy versus ligation in hemorrhage caused by rupture of esophageal varices. Direct meta-analysis of randomized trials. Gastroenterol Clin Biol. 1995 Nov; 19(11):914-20.
  22. Slosberg EA, K. E. (1997). Sclerotherapy versus banding in the treatment of variceal bleeding. Clin Liver Dis. 1997 May; 1(1):77-84, xi. Review.
  23. Gimson AE, R. J. (1993 aug). Randomised trial of variceal banding ligation versus injection sclerotherapy for bleeding oesophageal varices. 1993 Aug 14; 342(8868):391-4.
  24. Hou MC, L. H. Recurrence of esophageal varices following endoscopic treatment and its impact on rebleeding: comparison of sclerotherapy and ligation. J Hepatol. 2000 Feb;32(2):202-8.
  25. Saeed ZA, S. G.Endoscopic variceal ligation is superior to combined ligation and sclerotherapy for esophageal varices: a multicenter prospective randomized. 1997 Jan; 25(1):71-4.
  26. Avgerinos A, N. F. Early administration of somatostatin and efficacy of sclerotherapy in acute oesophageal variceal bleeds: the European Acute Bleeding Oesophageal Variceal Episodes (ABOVE) randomised trial. Lancet. 1997 Nov 22; 350(9090):1495-9..
  27. Runyon, B. A. (2010). Screening for esophageal varices. Retrieved from uptodate: http://www.uptodate.com/contents/patient-information-screening-for-esophageal-varices.
  28. Juan Carlos Garc?a-Pag?n, M. K. Early Use of TIPS in Patients with Cirrhosis and Variceal Bleeding. N Engl J Med 2010; 362:2370-2379.
  29. Cheema MA, S. M. Surgery for bleeding esophageal varices. J Pak Med Assoc. 1995 Jan; 45(1):6-9.
  30. Hirano S, K. S. Appraisal of DSRS with SPGD for esophagogastric varices: a retrospective comparative study according to the underlying liver diseases. 2005 Jan-Feb; 52(61):152-5.
  31. Zacks SL, Sandler RS, etc. Decision ? Analysis of transjugular intrahepatic porto systemic? Shunt Versus Distal Splenorenal shunts For Portal Hypertension: Hepatology. 1999: 29(5): 1399-405.
  32. GASIM, S. F.. Endoscopic Sclerotherapy for Bleeding Oesophageal Varices: Experience in Sudan. Tropical Gastroentrology , 23:107-109.
  33. Prevention and management of gastroesophageal variceal hemorrhage in cirrhosis. http://guidlines.gove/content.aspx?id=11370.
  34. Svoboda P, K. I. Preventive sclerotherapy of esophageal varices with a high risk of hemorrhage: a prospective randomized controlled study Rozhl Chir. 1999 Jul; 78(7):337-42.
  35. Madonia S, D. G. (2000). Prognostic indicators of successful endoscopic sclerotherapy for prevention of rebleeding from oesophageal varices in cirrhosis: a long-term cohort study. Dig Liver Dis. 2000 Dec; 32(9):782-91.
  36. Lo GH, L. K. Prophylactic banding ligation of high-risk esophageal varices in patients with cirrhosis: a prospective, randomized trial. J Hepatol. 1999 Sep;31(3):451-6.
  37. Azuma M, K. T. Evaluation of portosystemic collaterals by SPECT imaging after endoscopic variceal sclerotherapy: usefulness for predicting recurrence. J Nucl Med. 2000 Apr;41(4):600-4.
  38. Mudawi HMY, I. K. Endoscopic Variceal in Patients with Symmers periportal Fibrosis. Trop Doct ,2007. 27(3);179-81.
  39. FARID ABDEL-WAHAB, etc .. the epidemiology of schistosomiasis in egypt: fayoum governorate. Am. J. Trop. Med. Hyg ,2000. 62(2)55?64.
  40. Saad AM, Homeida M, etc. Oesophageal varices in a region of the Sudan endemic for Schistosoma mansoni. Br J Surg. 1991 Oct; 78(10):1252-3.
  41. El Masri SH, Hassan MA. Splenectomy ans vasoligation for patients with haematemesis secondary to bilharzial hepatic fibrosis. Br J Surg ,1982. (69)314-316.
  42. Mattos AZ, M. A.-L.. Platelet count/spleen diameter ratio: analysis of its capacity as a predictor of the existence of esophageal varices. Arq Gastroenterol. 2010 Sep; 47(3):275-8.
  43. Siang-Hiong Goh. Clinical predictors of bleeding esophageal varices in the ED. ajemjournal , 2005.23: (4)531-535
  44. Dumont, A. significant splenomegaly in Patients with bleeding esophageal varices. Ann Surg. 1970 April; 171(4): 522?526.

[Mohamed Gomah Hamed Alaqqad. (2017); BLEEDING OESOPHAGEAL VARICES, CLINICAL PRESENTATION AND OUTCOME OF MANAGEMENT IN WAD MADANI TEACHING HOSPITAL. Int. J. of Adv. Res. 5 (Oct). 342-361] (ISSN 2320-5407). www.journalijar.com

Mohamed

DOI:

Article DOI: 10.21474/IJAR01/5538      
DOI URL: https://dx.doi.org/10.21474/IJAR01/5538

Download Full Paper

Download PDF No. of Downloads: 10 | No. of Views: 89