Distinct course of portal hypertension in patients with cirrhosis with gastric variceal bleeding as their first decompensation: a propensity score-matched study

• Published in: Hepatology international Vol. 17; no. 2; pp. 427 - 433
• Main Authors: Sharma, Sanchit, Agarwal, Samagra, Madhu, Deepak, Rana, Randeep, Gupta, Anany, Gopi, Srikanth, Gunjan, Deepak, Saraya, Anoop
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.04.2023; Springer Nature B.V
• Subjects: Adult; Ascites; Ascites - complications; Bleeding; Cirrhosis; Colorectal Surgery; Esophageal and Gastric Varices - complications; Etiology; Fatalities; Female; Gastrointestinal Hemorrhage - epidemiology; Gastrointestinal Hemorrhage - etiology; Health risks; Hepatology; Humans; Hypertension; Hypertension, Portal; Liver cirrhosis; Liver Cirrhosis - complications; Male; Males; Medicine; Medicine & Public Health; Middle Aged; Original Article; Propensity Score; Retrospective Studies; Risk analysis; Subgroups; Surgery; Survival; Rebleeding; Ascites; Esophageal varices; Portal hypertension; Gastric varices
• ISSN: 1936-0533; 1936-0541
• DOI: 10.1007/s12072-022-10451-3

Background and aims Limited data exist on course of portal hypertension in patients with cirrhosis with gastric variceal (GV) bleeding as their index decompensation. We evaluated long-term outcomes in this subgroup and compared them with a propensity score-matched cohort of patients with esophageal variceal (EV) bleeding. Methods Patients with cirrhosis with GVs (IGV-1 and GOV-2) bleeding as their index decompensation were analyzed in this retrospective study. Incidence of new-onset clinical decompensations and survival were estimated and compared with a cohort of patients with EVs bleeding matched for etiology and disease severity using competing risk analysis. Results Baseline characteristics of patients with GVs related bleeding ( n  = 51) (mean age—48.1 ± 12.9 years, 80% males, non-viral cirrhosis: 80.3%) were similar to the cohort of EVs bleeding ( n  = 51) (mean age—45.9 ± 14.2, 88% males, non-viral cirrhosis: 78.4%). The 1-year and 3-year rates of new-onset ascites were (17.9%, 34.2%) and (23.9%, 49%) in patients with GVs and EVs related index bleeding, respectively (Gray’s test, p  = 0.035). The 1-year and 3 year rate of rebleed was (35.6%, 46.3%) and (13.9%, 35.7%) in patients with GVs and EVs related index bleeding, respectively (Gray’s test, p  = 0.1). While overall survival was similar across both the groups (GV: 29.6% vs EV: 21.6%, p  = 0.495), rebleeding-related deaths occurred exclusively in patients with GV (rebleeding-related deaths: GV: 40% vs EVs: 0%; non-bleeding liver-related deaths: GV: 60% vs EV: 100%; p  = 0.048). Conclusions Rebleeding predominates the course of portal hypertension in patients with cirrhosis presenting with GVs related bleeding, whereas ascites is the most significant event on follow-up in those with EVs related bleeding.