Correlation between diabetes mellitus and the clinical outcome of acute variceal bleeding in cirrhotic patients in Suez Canal University Hospital, Ismailia, Egypt

Abstract

Variceal bleeding is one of the major complications of portal hypertension. Gastro-esophageal varices are present 40-60% of patients with cirrhosis; bleeding occurs in 25-35% of patients and account for 80-90% of bleeding episodes in these patients. Hepatic venous pressure gradient (HVPG) > 20 mmHg is associated with early re-bleed and failure to control bleeding (83%) with high mortality (64%) In the last two decades variceal re-bleeding has decreased from 47% to 13% with the use of pharmacological, endoscopic, and radiological intervention.DM co-existing with cirrhosis is considered to be one of the factors in the genesis of variceal bleeding. This may be due to an increase in portal blood flow. is to determine the correlation between DM as a risk factor and failure to control variceal bleeding and re-bleeding in cirrhotic patients. This study is a case-control study, sixty cirrhotic patients with variceal bleeding with or without DM were included in the study. The patients were divided into two groups: Group 1 (diabetic group): this group included 30 cirrhotic patients with variceal bleeding and had a history of DM. Group 2 (control group): this group included 30 cirrhotic patients with variceal bleeding and had no history of DM. All Patients were subjected to the following:-Complete clinical evaluation (history and physical examination) with Laboratory and imaging investigations. Tthere were significantly higher frequency of unstable course and mean times of previous admission in diabetic patients than control patients (73.3% and 1.6 times versus 36.6% and 1.3 times, respectively). Other variables showed insignificant differences between both groups (p>0.05). There were significantly higher mean numbers of attacks of hematemesis and melena and times of previous admission with these attacks in diabetic patients than control patients.