Prevalence and outcome of peptic ulcer bleeding in patients with liver cirrhosis

Background: Upper gastrointestinal bleeding is usually classified as either variceal or non-variceal. In cirrhotic patients, variceal bleeding has been extensively studied but, 30–40% of cirrhotic patients who bleed have non-variceal upper gastrointestinal bleeding (NVUGIB) that is frequently caused by gastro duodenal ulcers. Peptic ulcer bleeding (PUB) leads to substantial morbidity and mortality in patients with liver cirrhosis. Aim: The aim of this study was to assess the prevalence and outcome of PUB in patients with liver cirrhosis. Materials and methods: This was a cross-sectional study. Data on cirrhotic patients with PUB over a seven-year period between January 2006 and January 2013 were collected. Results: Among 103 patients with NVUGIB, 62 patients (60%) having PUB were assessed. Fifty percent were male. Ages ranged from 37 to 72 years, mean 59 }7 years. The most common symptom on presentation was hematemesis (53%). Hemodynamic instability on admission was found in 30 patients (48%). Eighteen patients (29%) had initial hemoglobin less than 7 g/dl. Twenty-seven patients (44%) required blood transfusion and the average number of transfused blood units was two. Forty patients (65%) bled from gastric ulcers. Eleven patients (18%) had ulcers with adherent clot. Twenty-four percent of patients had a Rockall score more than five. Five patients (8%) rebled. Complications were reported in seven patients (11%), mainly liver failure. Overall mortality was 8%. Male gender, adherent clot, bleeding recurrence, development of complications during admission and a Rockall score 5 were significant factors for increasing mortality (P = 0.02, 0.016, 0.00001, 0.034 and 0.00003 respectively). Conclusion: The commonest cause of NVUGIB in patients with liver cirrhosis was PUB. Mortality in patients with PUB was particularly high among males, patients who had adherent clot, bleeding recurrence, development of complications and a high Rockall score.