Our aim were to describe the epidemiological and clinical as well as therapeutical features and to look for predictive factors of occurrence of gastrointestinal hemorrhage among cirrhotic patients. We included all cirrhotic patients with acute gastrointestinal hemorrhage hospitalized in the Service of Internal Medicine of Aristide Le Dantec University Teaching Hospital from January 1990 to December 1999. The diagnosis of cirrhosis was established according to two situations: prebiopsic criteria with clinical, biological, ultrasound and endoscopic data or the histological criteria. Gastrointestinal hemorrhage was present in 28.9% of the patients with an average age of 38.7 years and a sex ratio of 1.4. It revealed the cirrhosis in 82% of the cases, whether alone in 45.2% or associated with other complications in 36.8%. Previous bleeding episodes were found in 76 cases (9.6%). Gastrointestinal hemorrhage is the first cause of death among our cirrhotic patients with an overall mortality of 29.4%. The gastrointestinal hemorrhage was significantly associated with the young age (< 40 years). On the other hand, the clinical and biological parameters did not seem predictive of bleeding. The risk of hemorrhage was positively correlated with the presence of esophageal varices and their stage, the gastric varices and the portal gastropathy. The other lesions (watermelon stomach and erosive gastritis) did not seem to play a role in gastrointestinal hemorrhage. However the CHILD-PUGH classification was a poor predictor of either first hemorrhage or re-bleeding in this present study. We conclude that gastrointestinal hemorrhage is frequent among cirrhotic patients in our country. It constitute in this study the first cause of death in this population. instrumental treatment methods might prevent most of gastrointestinal hemorrhages in patients with high risk. |
