• cirrhosis
• endoscopic sclerotherapy
• hepatosplenomegaly
• hvpg
• oesophageal varices

• Humans
• Carcinoma, Hepatocellular/pathology
• Protons
• Retrospective Studies
• Liver Neoplasms/pathology
• Radiation Injuries/etiology
• Proton Therapy/adverse effects
• Proton Therapy/methods
• Radiotherapy Dosage

• Humans
• End Stage Liver Disease
• Esophageal and Gastric Varices/diagnosis
• Gastrointestinal Hemorrhage/diagnosis
• Severity of Illness Index
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnosis

• XGBoost
• acute kidney injury
• gastrointestinal bleeding
• intensive care unit
• machine learning

• Cirrhosis
• GI bleeding
• MELD-lactate
• Variceal bleeding

• Humans
• Esophageal and Gastric Varices/etiology
• Esophageal and Gastric Varices/complications
• Lactic Acid
• End Stage Liver Disease/complications
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Severity of Illness Index
• Liver Cirrhosis
• Prognosis
• Retrospective Studies

• K08 DK124577 NIDDK NIH HHS

• Emergency department
• Gastrointestinal hemorrhage
• In-hospital mortality
• Lactate

Upper gastrointestinal bleeding (UGIB) is a common complication in renal transplant recipients. However, the risk stratification value of bleeding scoring systems in these patients is unclear, and data regarding risk factors are limited.

Clinical data of renal transplant recipients in The Third Xiangya hospital were collected. The predictive ability of Glasgow Blatchford score (GBS), pre-endoscopy Rockall score (pRS), and AIMS65 score were assessed by the area under the receiver operating characteristic curve (AUROC). Risk factors of UGIB were analyzed using binary logistic regression analysis.

A total of 220 patients were enrolled, of which 55 with UGIB. Endoscopy improved the overall survival rate of patients. Glasgow Blatchford score (AUROC 0.868) performed best at predicting UGIB patients who need intervention or death, with a threshold of 10, sensitivity and specificity were 82.4% and 70%, respectively. In terms of predicting mortality, the GBS score was comparable with AIMS65 score (p = 0.30) and pRS score (p = 0.42). Viral hepatitis, intravenous hormone usage, low platelet count, and low albumin level were significant factors associated with UGIB.

The Glasgow Blatchford score (AUROC 0.868) was best at predicting the need for intervention or death. However, their ability to predict mortality was limited, with AUROC less than 0.8. Our study also identified four independent risk factors for renal transplant recipients with UGIB.

The online version contains supplementary material available at 10.1186/s12876-022-02426-3.

• AIMS65
• Glasgow Blatchford score
• Pre-endoscopy Rockall score
• Renal transplant recipient
• Upper gastrointestinal bleeding

• complications
• liver cirrhosis
• management
• practice guidance
• terlipressin

• COVID-19
• endoscopy
• gastrointestinal hemorrhage

Bacterial infections are associated with the risk of variceal bleeding through complex pathophysiologic pathways.

The primary objective of the present case-control study was to investigate the role of bacterial translocation and intestinal barrier dysfunction in the pathogenesis of variceal bleeding. A secondary objective was to determine independent predictors of key outcomes in variceal bleeding, including bleeding-related mortality.

Eighty-four (n = 84) consecutive patients participated in the study, 41 patients with acute variceal bleeding and 43 patients with stable cirrhosis, and were followed up for 6 weeks. Peripheral blood samples were collected at patient admission and before any therapeutic intervention.

Child-Pugh (CP) score (OR: 1.868; p = 0.044), IgM anti-endotoxin antibody levels (OR: 0.954; p = 0.016) and TGF-β levels (OR: 0.377; p = 0.026) were found to be significant predictors of variceal bleeding. Regression analysis revealed that albumin (OR: 0.0311; p = 0.023), CRP (OR: 3.234; p = 0.034) and FABP2 levels (OR:1.000, p = 0.040), CP score (OR: 2.504; p = 0.016), CP creatinine score (OR: 2.366; p = 0.008), end-stage liver disease model (MELD), Na (OR: 1.283; p = 0.033), portal vein thrombosis (OR: 0.075; p = 0.008), hepatocellular carcinoma (OR: 0.060; p = 0.003) and encephalopathy (OR: 0.179; p = 0.045) were significantly associated with 6-week mortality.

Bacterial translocation and gut barrier impairment are directly related to the risk of variceal bleeding. Microbiota-modulating interventions and anti-endotoxin agents may be promising strategies to prevent variceal bleeding.

• bacterial translocation
• cirrhosis
• intestinal barrier
• liver-gut axis
• variceal bleeding

Acute non-variceal bleeding accounts for approximately 20% of all-cause bleeding episodes in patients with liver cirrhosis. It is associated with high morbidity and mortality therefore prompt diagnosis and endoscopic management are crucial.

To evaluate available data on the efficacy of endoscopic treatment modalities used to control acute non-variceal gastrointestinal bleeding (GIB) in cirrhotic patients as well as to assess treatment outcomes.

Employing PRISMA methodology, the MEDLINE was searched through PubMed using appropriate MeSH terms. Data are reported in a summative manner and separately for each major non-variceal cause of bleeding.

Overall, 23 studies were identified with a total of 1288 cirrhotic patients of whom 958/1288 underwent endoscopic therapy for acute non-variceal GIB. Peptic ulcer bleeding was the most common cause of acute non-variceal bleeding, followed by portal hypertensive gastropathy, gastric antral vascular ectasia, Mallory-Weiss syndrome, Dieaulafoy lesions, portal hypertensive colopathy, and hemorrhoids. Failure to control bleeding from all-causes of non-variceal GIB accounted for less than 3.5% of cirrhotic patients. Rebleeding (range 2%-25%) and mortality (range 3%-40%) rates varied, presumably due to study heterogeneity. Rebleeding was usually managed endoscopically and salvage therapy using arterial embolisation or surgery was undertaken in very few cases. Mortality was usually associated with liver function deterioration and other organ failure or infections rather than uncontrolled bleeding. Endoscopic treatment-related complications were extremely rare. Lower acute non-variceal bleeding was examined in two studies (197/1288 patients) achieving initial hemostasis in all patients using argon plasma coagulation for portal hypertensive colopathy and endoscopic band ligation or sclerotherapy for bleeding hemorrhoids (rebleeding range 10%-13%). Data on the efficacy of endoscopic therapy of cirrhotic patients vs non-cirrhotic controls with acute GIB are very scarce.

Endotherapy seems to be efficient as a means to control non-variceal hemorrhage in cirrhosis, although published data are very limited, particularly those comparing cirrhotics with non-cirrhotics and those regarding acute bleeding from the lower gastrointestinal tract. Rebleeding and mortality rates appear to be relatively high, although firm conclusions may not be drawn due to study heterogeneity. Hopefully this review may stimulate further research on this subject and help clinicians administer optimal endoscopic therapy for cirrhotic patients.

• Liver cirrhosis
• Non-variceal gastrointestinal hemorrhage
• Gastrointestinal endoscopy
• Endoscopic therapy
• Patient outcomes
• Peptic ulcer
• Mallory Weiss syndrome
• Gastric antral vascular ectasia

• Children
• Endoscopic banding
• Primary prophylaxis
• Secondary prophylaxis

• ACLF, acute on chronic liver failure
• AFP, alpha fetoprotein
• AVB, acute variceal bleed
• CT, computer tomography
• CTP, Child–Turcotte–Pugh
• EASL-CLIF, European Association of Study of Liver Disease-Chronic Liver Failure Consortium
• EBL, endoscopic band ligation
• HE, hepatic encephalopathy
• HRS, hepatorenal syndrome
• HVPG, hepatic venous portal gradient
• MELD score
• MELD, model for end-stage liver disease
• NSBB, non-selective beta blockers
• SBP, spontaneous bacterial peritonitis
• UGIE, upper gastrointestinal endoscopy
• acute variceal bleed
• ascites
• carvedilol
• hepatic venous pressure gradient
• propranolol
• secondary prophylaxis

• Complications of cirrhosis
• Endoscopic variceal ligation
• Portal hypertension
• Variceal bleeding
• β-blockers

• Case report
• acute upper gastrointestinal bleeding
• ischemic stroke
• myocardial infarction

• Cirrhosis
• hemorrhage
• meta-analysis
• prognosis
• renal dysfunction

• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/mortality
• Humans
• Incidence
• Kidney/physiopathology
• Kidney Diseases/diagnosis
• Kidney Diseases/mortality
• Kidney Diseases/physiopathology
• Liver Cirrhosis/diagnosis
• Liver Cirrhosis/mortality
• Prognosis
• Risk Assessment
• Risk Factors

Hepatocellular carcinoma (HCC) is common cancer in ASEAN. Variceal bleeding (VB) is considered to be fatal complication of cirrhosis with HCC. However, limited studies were reported in ASEAN. Aim of this study was to evaluate overall survival rate and predictors of VB in HCC patients.

We conducted a retrospective cohort study of HCC patients aged ≥15 years between January 2012-January 2016 and follow up through June 2016 at Thammasat University Hospital, Thailand. Clinical information and radiologic findings were collected from reviewing computer database of medical records.

333 patients had completely retrievable information. Of which, 27 patients (8.1%) had documented with VB. Clinical presentations with weight loss and jaundice were higher in VB than non-VB groups (40.74% vs. 34.64%, p=0.525 and 7.41% vs. 2.29%, p=0.116) but the differences were not significant. The most common causes of cirrhosis in HCC patients with VB were chronic HBV infection (55.56%). In multivariate analysis; presence of ascites, Child-Pugh score>6, presence of varices were independent risk factors of having VB in HCC patients (OR=7.59, 95%CI=1.13-50.88, p=0.037; OR=5.07, 95%CI=1.08-23.76, p=0.039; OR=23.51, 95%CI=4.71-117.35, p<0.001, respectively). In HCC patients with VB, 1-year and 2.5-year survival rates were 56.6% and 28.3%.

HCC patients with ascites, Child-Pugh score>6 and presence of varices might be important predictive factors of VB. Having VB were greatly impact to the survival rate of HCC patients. Clinical suspicion and regular surveillance of VB in HCC patients at risk could improve treatment outcomes.

• Hepatocellular carcinoma
• variceal bleeding
• Thailand

• cirrhosis
• portal hypertension
• variceal bleeding

• body weight
• liver cirrhosis
• phase 2 clinical trial
• tolvaptan
• waist circumference

• Hematemesis
• Uganda
• case-control
• outbreak

• Balloon tamponade device
• Minnesota tube
• Sengstaken-Blakemore
• Tips
• Transjugular intrahepatic portosystemic shunt
• Variceal hemorrhage

• Hepatocellular carcinoma
• anatomical liver resection
• liver resection

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

To assess the beneficial and harmful effects of L‐ornithine L‐aspartate versus placebo, no intervention, or other active interventions for people with cirrhosis and hepatic encephalopathy.

AIM: To systematically review the data on distinctive aspects of peptic ulcer disease (PUD), Dieulafoy’s lesion (DL), and Mallory-Weiss syndrome (MWS) in patients with advanced alcoholic liver disease (aALD), including alcoholic hepatitis or alcoholic cirrhosis.

METHODS: Computerized literature search performed via PubMed using the following medical subject heading terms and keywords: “alcoholic liver disease”, “alcoholic hepatitis”,“ alcoholic cirrhosis”, “cirrhosis”, “liver disease”, “upper gastrointestinal bleeding”, “non-variceal upper gastrointestinal bleeding”, “PUD”, ‘‘DL’’, ‘‘Mallory-Weiss tear”, and “MWS’’.

RESULTS: While the majority of acute gastrointestinal (GI) bleeding with aALD is related to portal hypertension, about 30%-40% of acute GI bleeding in patients with aALD is unrelated to portal hypertension. Such bleeding constitutes an important complication of aALD because of its frequency, severity, and associated mortality. Patients with cirrhosis have a markedly increased risk of PUD, which further increases with the progression of cirrhosis. Patients with cirrhosis or aALD and peptic ulcer bleeding (PUB) have worse clinical outcomes than other patients with PUB, including uncontrolled bleeding, rebleeding, and mortality. Alcohol consumption, nonsteroidal anti-inflammatory drug use, and portal hypertension may have a pathogenic role in the development of PUD in patients with aALD. Limited data suggest that Helicobacter pylori does not play a significant role in the pathogenesis of PUD in most cirrhotic patients. The frequency of bleeding from DL appears to be increased in patients with aALD. DL may be associated with an especially high mortality in these patients. MWS is strongly associated with heavy alcohol consumption from binge drinking or chronic alcoholism, and is associated with aALD. Patients with aALD have more severe MWS bleeding and are more likely to rebleed when compared to non-cirrhotics. Pre-endoscopic management of acute GI bleeding in patients with aALD unrelated to portal hypertension is similar to the management of aALD patients with GI bleeding from portal hypertension, because clinical distinction before endoscopy is difficult. Most patients require intensive care unit admission and attention to avoid over-transfusion, to correct electrolyte abnormalities and coagulopathies, and to administer antibiotic prophylaxis. Alcoholics should receive thiamine and be closely monitored for symptoms of alcohol withdrawal. Prompt endoscopy, after initial resuscitation, is essential to diagnose and appropriately treat these patients. Generally, the same endoscopic hemostatic techniques are used in patients bleeding from PUD, DL, or MWS in patients with aALD as in the general population.

CONCLUSION: Nonvariceal upper GI bleeding in patients with aALD has clinically important differences from that in the general population without aALD, including: more frequent and more severe bleeding from PUD, DL, or MWS.

• Alcoholic liver disease
• Alcoholic hepatitis
• Cirrhosis
• Portal hypertension
• Peptic ulcer disease
• Mallory-Weiss syndrome
• Dieulafoy lesion
• Endoscopic therapy

• Arteries/pathology
• Endoscopy, Gastrointestinal
• Female
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/pathology
• Gastrointestinal Hemorrhage/therapy
• Humans
• Hypertension, Portal/complications
• Liver Cirrhosis/complications
• Liver Diseases, Alcoholic/complications
• Male
• Mallory-Weiss Syndrome/etiology
• Peptic Ulcer/etiology
• Risk Factors

• creatinine
• cystatin C
• glomerular filtration rate
• outcome

• Acute kidney injury
• RIFLE criteria
• hospital costs
• mortality
• upper gastrointestinal bleeding

• Acute Disease
• Antifibrinolytic Agents/therapeutic use
• Chronic Disease
• Gastrointestinal Hemorrhage/drug therapy
• Gastrointestinal Hemorrhage/etiology
• Humans
• Liver Diseases/complications
• Vitamin K/therapeutic use

• cirrhotics
• predictors of mortality
• variceal bleeding

AIM: To investigate the risk factors for 6-wk rebleeding and mortality in acute variceal hemorrhage (AVH) patients treated by percutaneous transhepatic variceal embolization (PTVE).

METHODS: A retrospective cohort study of AVH patients who had undergone PTVE treatment was conducted between January 2010 and December 2012. Demographic information, medical histories, physical examination findings, and laboratory test results were collected. The PTVE procedure was performed as a rescue therapy for patients who failed endoscopic and pharmacologic treatment. Survival analysis was estimated using the Kaplan-Meier method and compared using the log-rank test. The multivariate analysis was performed using the Cox regression test to identify independent risk factors for rebleeding and mortality.

RESULTS: One hundred and one patients were included; 71 were males and the average age was 51 years. Twenty-one patients rebled within 6 wk. Patients with high-risk stigmata, PTVE with trunk obliteration, and a hepatic vein pressure gradient (HVPG) ≥ 20 mmHg were at increased risk for rebleeding (OR = 5.279, 95%CI: 2.782-38.454, P = 0.003; OR = 4.309, 95%CI: = 2.144-11.793, P < 0.001; and OR = 1.534, 95%CI: 1.062-2.216, P = 0.022, respectively). Thirteen patients died within 6 wk. A model for end-stage liver disease (MELD) score ≥ 18 and an HVPG ≥ 20 mmHg were associated with 6-wk mortality (OR = 2.162, 95%CI: 1.145-4.084, P = 0.017 and OR = 1.423, 95%CI: 1.222-1.657, P < 0.001, respectively).

CONCLUSION: MELD score and HVPG in combination allow for early identification of patients with AVH who are at substantially increased risk of death over the short term.

• Acute variceal hemorrhage
• Percutaneous transhepatic variceal embolization
• Hepatic vein pressure gradient

• Acute Disease
• Adult
• Embolization, Therapeutic/adverse effects
• Embolization, Therapeutic/mortality
• Esophageal and Gastric Varices/diagnosis
• Esophageal and Gastric Varices/mortality
• Esophageal and Gastric Varices/physiopathology
• Esophageal and Gastric Varices/therapy
• Female
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/mortality
• Gastrointestinal Hemorrhage/physiopathology
• Gastrointestinal Hemorrhage/therapy
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Portal Pressure
• Portal Vein/physiopathology
• Proportional Hazards Models
• Recurrence
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome

• Adjuvant therapy
• Chronic liver disease
• Hepatocellular carcinoma
• Liver resection
• Patient's selection
• Preoperative management
• Recurrence

• liver disease
• paracentesis
• acute-on-chronic liver failure
• bowel ischemia

• 1-Year survival
• Cirrhosis-related complications
• CrCTP score
• Prognostic models
• Sodium-based MELD variants