Published online Jan 21, 2017. doi: 10.3748/wjg.v23.i3.496
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
To determine the prognostic factors associated with mortality in patients with gastric fundal variceal (GFV) bleeding.
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.
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).
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.
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.