Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2017; 23(3): 496-504
Published online Jan 21, 2017. doi: 10.3748/wjg.v23.i3.496
Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding
Keishi Komori, Masaru Kubokawa, Eikichi Ihara, Kazuya Akahoshi, Kazuhiko Nakamura, Kenta Motomura, Akihide Masumoto
Keishi Komori, Masaru Kubokawa, Kazuya Akahoshi, Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Eikichi Ihara, Kazuhiko Nakamura, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
Kenta Motomura, Akihide Masumoto, Department of Hepatology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Author contributions: Komori K and Kubokawa M designed this study and mainly wrote the manuscript; Ihara E, Akahoshi K, Nakamura K, Motomura K, and Masumoto A supervised this study.
Institutional review board statement: This study was reviewed and approved by the ethics committee of Aso Iizuka Hospital. It was conducted in accordance with the ethical principles of the Declaration of Helsinki and in compliance with good clinical practice.
Informed consent statement: This was a retrospective study using routinely collected data, and the results had no impact on the participants. Patients were not required to give informed consent for the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. The information regarding this study has been posted on the website of Aso Iizuka Hospital at (http://aih-net.com/shared/oshirase/rinri_201604-008.html).
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Masaru Kubokawa, MD, PhD, Department of Gastroenterology, Aso Iizuka Hospital, 3-83 Yoshio, Iizuka 820-8505, Japan. mkubokawah1@aih-net.com
Telephone: +81-948-223800 Fax: +81-948-298747
Received: September 23, 2016
Peer-review started: September 26, 2016
First decision: December 2, 2016
Revised: December 13, 2016
Accepted: December 21, 2016
Article in press: December 21, 2016
Published online: January 21, 2017
Processing time: 112 Days and 18.8 Hours
Abstract
AIM

To determine the prognostic factors associated with mortality in patients with gastric fundal variceal (GFV) bleeding.

METHODS

In total, 42 patients were endoscopically diagnosed with GFV bleeding from January 2000 to March 2014. We retrospectively reviewed the patients' medical records and assessed their history, etiology of liver cirrhosis, disease conditions, treatment options for GFV bleeding, medications administered before and after onset of GFV bleeding, blood test results (hemoglobin, albumin, and bilirubin concentrations), and imaging results (including computed tomography and abdominal ultrasonography). We also assessed the prognostic factors associated with short-term mortality (up to 90 d) and long-term mortality in all patients.

RESULTS

Multivariate analysis showed that prophylactic administration of antibiotics was an independent prognostic factor associated with decreases in short-term mortality (OR = 0.08, 95%CI: 0.01-0.52) and long-term mortality (OR = 0.27, 95%CI: 0.08-0.91) in patients with GFV bleeding. In contrast, concurrent hepatocellular carcinoma (HCC) and regular use of proton pump inhibitors (PPI) were independent prognostic factors associated with increases in short-term mortality (HCC: OR = 15.4, 95%CI: 2.08-114.75; PPI: OR = 12.76, 95%CI: 2.13-76.52) and long-term mortality (HCC: OR = 7.89, 95%CI: 1.98-31.58; PPI: OR = 10.91, 95%CI: 2.86-41.65) in patients with GFV bleeding. The long-term overall survival rate was significantly lower in patients who regularly used PPI than in those who did not use PPI (P = 0.0074).

CONCLUSION

Administration of antibiotics is associated with decreased short- and long-term mortality, while concurrent HCC and regular PPI administration are associated with increased short- and long-term mortality.

Keywords: Antibiotics; Gastric varices; Gastric fundus; Proton pump inhibitors; Hemorrhage

Core tip: Bleeding from gastric fundal varices is associated with high mortality. This study aimed to clarify the prognostic factors associated with short- and long-term mortality of patients with gastric fundal variceal (GFV) bleeding and, in particular, to determine the effect of prophylactic antibiotic administration on the outcome in patients with GFV bleeding. Antibiotic administration was associated with decreases in short- and long-term mortality in patients with GFV bleeding; concurrent hepatocellular carcinoma and use of a proton pump inhibitor were independent factors associated with an increase in short- and long-term mortality.