Potential precipitating factors of variceal bleeding

Background and study aim: Variceal bleeding accounts for 10-30% of upper gastrointestinal haemorrhage and is a major cause of death in patients with cirrhosis. The incidence of chronic liver disease and hence portal hypertension in Egypt is exceptionally high, maintaining the highest prevalence of hepatitis C virus (HCV) worldwide, bilharzial periportal fibrosis as well as rising rates of hepatocellular carcinoma (HCC). In this work, we prospectively studied the potential precipitating factors for variceal bleeding in Middle Delta, Egypt. Patients and methods: Four hundred consecutive patients with liver cirrhosis who presented to Tanta University Hospital, from April 2011 till October 2011 with endoscopy documented acute variceal bleeding were invited to participate in the study. Our patients were classified into: Group I: 400 Patients with liver cirrhosis and acute variceal bleeding. Group II: 50 Matched patients with same Child-Pugh class and esophageal varices without bleeding (As a control group). All patients included in the study will be subjected to full history taking with a standard questionnaire regarding constipation, vomiting, cough, and other potential risk factors. Result: Vomiting, constipation and sever cough showed significant statistical increase in bleeding patients than the control group. (P.value < 0.05). The relation between the constipation and vomiting and the recurrence of bleeding was statistically significant. (P value < 0.05). Conclusion: Straining activities and infection could precipitate variceal bleeding episode. Routine vaccination, proper management of infection will reduce bleeding and rebleeding episode in cirrhotic patients with varices.