Digestive Diseases and Sciences

, Volume 57, Issue 11, pp 2743–2754 | Cite as

Non-variceal Gastrointestinal Bleeding in Patients with Liver Cirrhosis: A Review

  • M. Kalafateli
  • C. K. TriantosEmail author
  • V. Nikolopoulou
  • A. Burroughs



Non-variceal gastrointestinal (NVGI) bleeding in cirrhosis may be associated with life-threatening complications similar to variceal bleeding.


To review NVGI bleeding in cirrhosis.


MEDLINE, Scopus, and ISI Web of Knowledge were searched, using the textwords “portal hypertensive gastropathy,” “gastric vascular ectasia,” “peptic ulcer,” “Dieulafoy’s,” “Mallory–Weiss syndrome,” “portal hypertensive enteropathy,” “portal hypertensive colopathy,” “hemorrhoids,” and “cirrhosis.”


Portal hypertensive gastropathy (PHG) and gastric vascular ectasia (GVE) are gastric lesions that most commonly present as chronic anemia; acute upper GI (UGI) bleeding is a rare manifestation. Management of PHG-related bleeding is mainly pharmacological, whereas endoscopic intervention is favored in GVE-related bleeding. Shunt therapies or more invasive techniques are restricted in refractory cases. Despite its high incidence in cirrhotic patients, peptic ulcer accounts for a relatively small proportion of UGI bleeding in this patient population. However, in contrary to general population, the pathogenetic role of Helicobacter pylori infection remains questionable. Finally, other causes of UGI bleeding include Dieulafoy’s lesion, Mallory–Weiss syndrome, and portal hypertensive enteropathy. The most common non-variceal endoscopic findings reported in patients with lower gastrointestinal bleeding are portal hypertensive colopathy and hemorrhoids. However, the vast majority of studies are case reports and, therefore, the incidence, diagnosis, and risk of bleeding remain undefined. Endoscopic interventions, shunting procedures, and surgical techniques have been described in this setting.


The data on NVGI bleeding in liver cirrhosis are surprisingly scanty. Large, multicenter epidemiological studies are needed to better assess prevalence and incidence and, most importantly, randomized studies should be performed to evaluate the success rates of therapeutic algorithms.


Liver cirrhosis Gastrointestinal hemorrhage Portal hypertension Review 


Conflicts of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Schlichting P, Christensen E, Fauerholdt L, Poulsen H, Juhl E, Tygstrup N. Main causes of death in cirrhosis. Scand J Gastroenterol. 1983;18:881–888.PubMedGoogle Scholar
  2. 2.
    Franco D, Durandy Y, Deporte A, Bismuth H. Upper gastrointestinal haemorrhage in hepatic cirrhosis: causes and relation to hepatic failure and stress. Lancet. 1977;1:218–220.PubMedGoogle Scholar
  3. 3.
    Graham DY, Smith JL. The course of patients after variceal hemorrhage. Gastroenterology. 1981;80:800–809.PubMedGoogle Scholar
  4. 4.
    Christensen E, Krintel JJ, Meltofte Hansen S, Krogh Johansen J, Juhl E. Prognosis after the first episode of gastrointestinal bleeding or coma in cirrhosis. Survival and prognosis. Scand J Gastroenterol. 1989;24:999–1006.PubMedGoogle Scholar
  5. 5.
    Garden OJ, Motyl H, Gilmour WH, Utley RJ, Carter DC. Prediction of outcome following acute variceal haemorrhage. Br J Surg. 1985;72:91–95.PubMedGoogle Scholar
  6. 6.
    Cardenas A, Gines P, Uriz J, et al. Renal failure after upper gastrointestinal bleeding in cirrhosis: incidence, clinical course, predictive factors, and short-term prognosis. Hepatology. 2001;34:671–676.PubMedGoogle Scholar
  7. 7.
    Navasa M, Rimola A, Rodes J. Bacterial infections in liver disease. Semin Liver Dis. 1997;4:323–333.Google Scholar
  8. 8.
    Runyon BA. Bacterial infections in patients with cirrhosis. J Hepatol. 1993;18:271–272.PubMedGoogle Scholar
  9. 9.
    Burroughs AK, Triantos CK. Predicting failure to control bleeding and mortality in acute variceal bleeding. J Hepatol. 2008;48:185–188.PubMedGoogle Scholar
  10. 10.
    D’Amico G, DeFranchis R. Cooperative Study Group. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology. 2003;38:599–612.PubMedGoogle Scholar
  11. 11.
    Afessa B, Kubilis PS. Upper gastrointestinal bleeding in patients with hepatic cirrhosis: clinical course and mortality prediction. American J Gastroenterol. 2000;95:484–489.Google Scholar
  12. 12.
    Primignani M, Carpinelli L, Preatoni P, et al. Natural history of portal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscopic Club for the study and treatment of esophageal varices (NIEC). Gastroenterology. 2000;119:181–187.PubMedGoogle Scholar
  13. 13.
    D’Amico G, Montanalbo L, Traina M, et al. Natural history of congestive gastropathy in cirrhosis. The liver study group of V. Cervello Hospital. Gastroenterology. 1990;99:1558–1564.PubMedGoogle Scholar
  14. 14.
    Merli M, Nicolini G, Angeloni S, Gentili F, Attili AF, Riggio O. The natural history of portal hypertensive gastropathy in patients with liver cirrhosis and mild portal hypertension. Am J Gastroenterol. 2004;99:1959–1965.PubMedGoogle Scholar
  15. 15.
    Iwao T, Toyonaga A, Oho K, et al. Portal-hypertensive gastropathy develops less in patients with cirrhosis and fundal varices. J Hepatol. 1997;26:1235–1241.PubMedGoogle Scholar
  16. 16.
    Iwao T, Toyonaga A, Sumino M, et al. Portal hypertensive gastropathy in patients with cirrhosis. Gastroenterology. 1992;102:2060–2065.PubMedGoogle Scholar
  17. 17.
    Fontana R, Sanyal A. The HALT-C trial Group et al. Portal hypertensive gastropathy in chronic Hepatitis C patients with bridging fibrosis and compensated cirrhosis: results from the HALT-C Trial. Am J Gastroenterol. 2006;101:983–992.PubMedGoogle Scholar
  18. 18.
    Sarin S, Sreenivas D, Lahoti D, Saraya A. Factors influencing development of portal hypertensive gastropathy in patients with portal hypertension. Gastroenterology. 1992;102:994–999.PubMedGoogle Scholar
  19. 19.
    Sarin S, Misra S, Singal A, Thorat V, Broor S. Evaluation of the incidence and significance of the “Mosaic Pattern” in patients with cirrhosis, noncirrhotic portal fibrosis, and extrahepatic obstruction. Am J Gastroenterol. 1988;83:1235–1239.PubMedGoogle Scholar
  20. 20.
    Franchis De. Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V Consensus workshop on methology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;53:762–768.PubMedGoogle Scholar
  21. 21.
    Loperfido S, Baldo V, Piovesana E, et al. Changing trends in acute upper-GI bleeding: a population-based study. Gastrointest Endosc. 2009;70:212–224.PubMedGoogle Scholar
  22. 22.
    Gostout C, Viggiano T, Balm R. Acute gastrointestinal bleeding from portal hypertensive gastropathy: prevalence and clinical features. Am J Gastroenterol. 1993;88:2030–2033.PubMedGoogle Scholar
  23. 23.
    Hosking S, Kennedy H, Seddon I, Triger D. The role of propanolol in congestive gastropathy of portal hypertension. Hepatology. 1987;7:437–441.PubMedGoogle Scholar
  24. 24.
    Kouroumalis EA, Koutroubakis IE, Manousos ON. Somatostatin for acute severe bleeding from portal hypertensive gastropathy. Eur J Gastroenterol Hepatol. 1998;10:509–512.PubMedGoogle Scholar
  25. 25.
    Zhou Y, Qiao L, Wu J, Hu H, Xu C. Control of bleeding in portal hypertensive gastropathy: comparison of the efficacy of octreotide, vasopressin, and omeprazole in the control of acute bleeding in patients with portal hypertensive gastropathy. A controlled study. J Gastroenterol Hepatol. 2002;17:973–979.PubMedGoogle Scholar
  26. 26.
    Bruha R, Marecek Z, Spicak J, et al. Double-blind randomized, comparative multicenter study of the effect of terlipressin in the treatment of acute esophageal variceal and/or hypertensive gastropathy bleeding. Hepatogastroenterology. 2002;49:1161–1166.PubMedGoogle Scholar
  27. 27.
    Mezawa S, Homma H, Ohta H, et al. Effect of transjugular intrahepatic portosystemic shunt formation on portal hypertensive gastropathy and gastric circulation. Am J Gastroenterol. 2001;96:1155–1159.PubMedGoogle Scholar
  28. 28.
    Kamath P, Lacerda M, Ahlquist D, McKusick MA, Andrews JC, Nagorney DA. Gastric Mucosal Responses to intrahepatic portosystemic shunting in patients with cirrhosis. Gastroenterol. 2000;118:905–911.Google Scholar
  29. 29.
    De Franchis R. Portal hypertension II. Proceedings of the Second Baveno International Consensus Workshop on Definitions, Methodology, and Therapeutic Strategies. Oxford: Blackwell Science, 1996; 30–55.Google Scholar
  30. 30.
    Perez-Ayuso R, Pique J, Bosch J, et al. Propanolol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis. Lancet. 1991;337:1431–1434.PubMedGoogle Scholar
  31. 31.
    Ripoll C, Garcia-Tsao G. The management of portal hypertensive gastropathy and gastric antral vascular ectasia. Dig Liver Dis. 2011;43:345–351.PubMedGoogle Scholar
  32. 32.
    Panes J, Bordas JM, Pique JM, et al. Effects of propranolol on gastric mucosal perfusion in cirrhotic patients with portal hypertensive gastropathy. Hepatology. 1993;17:213–218.PubMedGoogle Scholar
  33. 33.
    Lo GH, Lai KH, Cheng JS, et al. The effects of endoscopic variceal ligation and propranolol on portal hypertensive gastropathy: a prospective, controlled trial. Gastrointest Endosc. 2001;53:579–584.PubMedGoogle Scholar
  34. 34.
    Urata J, Yamashita Y, Tsuchigame T, et al. The effects of transjugular intrahepatic portosystemic shunt on portal hypertensive gastropathy. J Gastroenterol Hepatol. 1998;118:1061–1067.Google Scholar
  35. 35.
    Vignali C, Bargellini I, Grosso M, et al. TIPS with expanded polytetrafluoroethylene-covered stent: results of an Italian multicenter study. Am J Roentgenol. 2005;185:472–480.Google Scholar
  36. 36.
    Gostout CJ, Viggiano TR, Ahlquist DA, Wang KK, Larson MV, Balm R. The clinical and endoscopic spectrum of the watermelon stomach. J Clin Gastroenterol. 1992;15:256–263.PubMedGoogle Scholar
  37. 37.
    Payen JL, Calès P, Voigt JJ, et al. Severe portal hypertensive gastropathy and antral vascular ectasia are distinct entities in patients with cirrhosis. Gastroenterology. 1995;108:138.PubMedGoogle Scholar
  38. 38.
    Vincent C, Pomier-Layrargues G, Dagenais M, et al. Cure of gastric antral vascular ectasia by liver transplantation despite persistent portal hypertension: a clue for pathogenesis. Liver Transpl. 2002;8:717–720.PubMedGoogle Scholar
  39. 39.
    Jutabha R, Jensen DM. Management of upper gastrointestinal bleeding in the patient with chronic liver disease. Med Clin North Am. 1996;80:1035.PubMedGoogle Scholar
  40. 40.
    Liberski SM, McGarrity TJ, Hartle RJ, Varano V, Reynolds D. The watermelon stomach: long-term outcome in patients treated with Nd:YAG laser therapy. Gastrointest Endosc. 1994;40:584–587.PubMedGoogle Scholar
  41. 41.
    Tobin RW, Hackman RC, Kimmey MB, et al. Bleeding from gastric antral vascular ectasia in marrow transplant patients. Gastrointest Endosc. 1996;44:223–229.PubMedGoogle Scholar
  42. 42.
    Yamamoto M, Takahashi H, Akaike J, et al. Gastric antral vascular ectasia (GAVE) associated with systemic sclerosis. Scand J Rheumatol. 2008;37:315–316.PubMedGoogle Scholar
  43. 43.
    Ingraham KM, O’Brien MS, Shenin M, Derk CT, Steen VD. Gastric antral vascular ectasia in systemic sclerosis: demographics and disease predictors. J Rheumatol. 2010;37:603–607.PubMedGoogle Scholar
  44. 44.
    Spahr L, Villeneuve JP, Dufresne MP, et al. Gastric antral vascular ectasia in cirrhotic patients: absence of relation with portal hypertension. Gut. 1999;44:739–742.PubMedGoogle Scholar
  45. 45.
    Ward EM, Raimondo M, Rosser BG, Wallace MB, Dickson RD. Prevalence and natural history of gastric antral vascular ectasia in patients undergoing orthotopic liver transplantation. J Clin Gastroenterol. 2004;38:898–900.PubMedGoogle Scholar
  46. 46.
    Herman BE, Vargo JJ, Baum S, Silverman ED, Eisold J. Gastric antral vascular ectasia: a case report and review of the literature. J Nucl Med. 1996;37:854.PubMedGoogle Scholar
  47. 47.
    Barnard GF, Colby JM, Saltzman JR, Krims PE, Li L, Banner BF. Endoscopic ultrasound appearance of watermelon stomach. Abdom Imaging. 1995;20:26.PubMedGoogle Scholar
  48. 48.
    Tsai HH, Smith J, Danesh BJ. Successful control of bleeding from gastric antral vascular ectasia (watermelon stomach) by laser photocoagulation. Gut. 1991;32:93–94.PubMedGoogle Scholar
  49. 49.
    Lingenfelser T, Mueller M, Marks IN, Dette S, Wehrman M, Scheurlen M. Endoscopic laser therapy in a case of gastric antral vascular ectasia. Z Gastroenterol. 1993;31:322–324.PubMedGoogle Scholar
  50. 50.
    Yamada M, Nishimura D, Hoshino H, Katada N, Sano H, Kato K. Gastric antral vascular ectasia successfully treated by endoscopic electrocoagulation. J Gastroenterol. 1998;33:546–549.PubMedGoogle Scholar
  51. 51.
    Tominaga K, Arakawa T, Taguchi M, et al. Histological examination of the efficacy of endoscopic laser coagulation therapy for diffuse antral vascular ectasia. Eur J Gastroenterol Hepatol. 2000;12:469–472.PubMedGoogle Scholar
  52. 52.
    Poniachik J, Quera R, Saenz R, Alfaro J, Smok G. Endoscopic coagulation with argon plasma, a therapeutic option in gastric antral vascular ectasia. Rev Med Chil. 2001;129:547–551.PubMedGoogle Scholar
  53. 53.
    Lee BJ, Park JJ, Seo YS, et al. Upper gastrointestinal bleeding from duodenal vascular ectasia in a patients with cirrhosis. World J Gastroenterol. 2007;13:5154–5157.PubMedGoogle Scholar
  54. 54.
    Lecleire S, Ben-Soussan E, Antonietti M, et al. Bleeding gastric vascular ectasia treated by argon plasma coagulation: a comparison between patients with and without cirrhosis. Gastrointest Endosc. 2008;67:219–225.PubMedGoogle Scholar
  55. 55.
    Bhatti MA, Khan AA, Alam A, Butt AK, Shafqat F, Malik K. Successful treatment of watermelon stomach/GAVE syndrome by using argon plasma coagulation. J Coll Physicians Surg Pak. 2008;18:641–643.PubMedGoogle Scholar
  56. 56.
    Rosenfeld G, Enns R. Argon photocoagulation in the treatment of gastric antral vascular ectasia and radiation proctitis. Can J Gastroenterol. 2009;23:801–804.PubMedCentralPubMedGoogle Scholar
  57. 57.
    Fuccio L, Zagari RM, Serrani M, et al. Endoscopic argon plasma coagulation for the treatment of gastric antral vascular ectasia-related bleeding in patients with liver cirrhosis. Digestion. 2009;79:143–150.PubMedGoogle Scholar
  58. 58.
    Bhatti MA, Jhan AA, Alam A, et al. Efficacy of argon plasma coagulation in gastric vascular ectasia in patients with liver cirrhosis. J Coll Physicians Surg Pak. 2009;19:219–222.PubMedGoogle Scholar
  59. 59.
    Wells CD, Harrison ME, Gurudu SR, et al. Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation. Gastrointest Endosc. 2008;68:231–236.PubMedGoogle Scholar
  60. 60.
    Nardone G, Rocco A, Balzano T, Budillon G. The efficacy of octreotide therapy in chronic bleeding due to vascular abnormalities of the gastrointestinal tract. Aliment Pharmacol Ther. 1999;13:1429–1436.PubMedGoogle Scholar
  61. 61.
    Tran A, Villeneuve JP, Bilodeau M, et al. Treatment of chronic bleeding from gastric antral vascular ectasia (GAVE) with estrogen-progesterone in cirrhotic patients: an open pilot study. Am J Gastroenterol. 1999;94:2909–2911.PubMedGoogle Scholar
  62. 62.
    McCormick PA, Ooi H, Crosbie O. Tranexamic acid for severe bleeding gastric antral vascular ectasia in cirrhosis. Gut. 1998;42:750–752.PubMedGoogle Scholar
  63. 63.
    Toyota M, Hinoda Y, Nakagawa N, et al. Gastric antral vascular ectasia causing severe anemia. J Gastroenterol. 1996;31:710–713.PubMedGoogle Scholar
  64. 64.
    Estevez P, Jimenez FP. Vascular ectasia of the gastric antrum as the cause of chronic digestive hemorrhage. Presentation of a case. Acta Gastroenterol Latinoam. 1999;29:325–330.PubMedGoogle Scholar
  65. 65.
    Tuveri M, Borsezio V, Gabbas A, Mura G. Gastric antral vascular ectasia-an unusual cause of gastric outlet obstruction: report of a case. Surg Today. 2007;37:503–505.PubMedGoogle Scholar
  66. 66.
    Siringo S, Burroughs AK, Bolondi L, et al. Peptic ulcer and its course in cirrhosis: an endoscopic and clinical prospective study. J Hepatol. 1995;22:633–641.PubMedGoogle Scholar
  67. 67.
    Siringo S, Bolondi L, Piscaglia F, et al. Peptic ulcer in patients with liver cirrhosis: a retrospective endoscopic and clinical study. Ital J Gastroenterol Hepatol. 1997;29:62–68.PubMedGoogle Scholar
  68. 68.
    Cryer B, Spechler SJ. Peptic ulcer disease. In: Felman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s gastrointestinal and liver disease. 8th ed. Philadelphia: Saunders; 2006:1089–1110.Google Scholar
  69. 69.
    Zullo A, Hassan C, Morini S. Helicobacter pylori infection in patients with liver cirrhosis: facts and fiction. Dig Liver Dis. 2003;35:197–205.PubMedGoogle Scholar
  70. 70.
    Fraser AG, Pounder RE, Burroughs AK. Gastric secretion and peptic ulceration in cirrhosis. J Hepatol. 1993;19:171–182.PubMedGoogle Scholar
  71. 71.
    Marshall BJ. Helicobacter pylori. Am J Gastroenterol. 1994;89:S116–S128.PubMedGoogle Scholar
  72. 72.
    Graham DY, Sung JJ. Helicobacter pylori. In: Felman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s gastrointestinal and liver disease. 8th ed. Philadelphia: Saunders; 2006:1049–1066.Google Scholar
  73. 73.
    Kim DJ, Kim HY, Kim SJ, et al. Helicobacter pylori infection and peptic ulcer disease in patients with liver cirrhosis. Korean J Internal Med. 2008;23:16–21.Google Scholar
  74. 74.
    Siringo S, Vaira D, Menegatti M, et al. High prevalence of Helicobacter pylori in liver cirrhosis. Dig Dis Sci. 1997;42:2024–2030.PubMedGoogle Scholar
  75. 75.
    Tzathas C, Triantafyllou K, Mallas E, Triantafyllou G, Ladas SD. Effect of Helicobacter pylori eradication and antisecretory maintenance therapy on peptic ulcer recurrence in cirrhotic patients: a prospective, cohort 2-year follow-up study. J Clin Gastroenterol. 2008;42:744–749.PubMedGoogle Scholar
  76. 76.
    Kitano S, Dolgor B. Does portal hypertension contribute to the pathogenesis of gastric ulcer associated with liver cirrhosis? J Gastroenterol. 2000;35:79–86.PubMedGoogle Scholar
  77. 77.
    Suzuki H, Ishii H. Peptic ulcer disease complicated with liver cirrhosis. Nippon Rinsho. 2004;62:532–540.PubMedGoogle Scholar
  78. 78.
    Kirk AP, Dooley JS, Hunt RH. Peptic ulceration in patients with liver disease. Dig Dis Sci. 1980;25:756–760.PubMedGoogle Scholar
  79. 79.
    Mitchell CJ, Jewell DP. The diagnosis of the site of upper gastrointestinal haemorrhage in patients with established portal hypertension. Endoscopy. 1977;9:131–135.PubMedGoogle Scholar
  80. 80.
    Rockall TA, Logan RFA, Devlin HB, Northfield TC. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Br Med J. 1995;311:222–226.Google Scholar
  81. 81.
    Svoboda P, Ehrmann J, Klvana P, Machytka E, Rydlo M, Hrabovsky V. The etiology of upper gastrointestinal bleeding in patients with liver cirrhosis. Vnitr Lek. 2007;53:1274–1277.PubMedGoogle Scholar
  82. 82.
    Gonzalez–Gonzalez JA, Garcia-Compean D, Vazquez-Elizondo G, Garza-Galindo A, Jaquez-Quintana JO, Maldonado-Garza H. Nonvariceal upper gastrointestinal bleeding in patients with liver cirrhosis. Clinical features, outcomes and predictors of in-hospital mortality. A prospective study. Ann Hepatol. 2011;10:287–295.PubMedGoogle Scholar
  83. 83.
    Castro-Fernandez M, Sanchez-Munoz D, Galan-Jurado MV, et al. Influence of nonsteroidal anti-inflammatory drugs in gastrointestinal bleeding due to gastroduodenal ulcers or erosions in patients with liver cirrhosis. Gastroenterol Hepatol. 2006;29:11–14.PubMedGoogle Scholar
  84. 84.
    Hsu YC, Lin JT, Chen TT, Wu MS, Wu CY. Long-term risk of recurrent peptic ulcer bleeding in patients with liver cirrhosis: a 10-year nationwide cohort study. Hepatology. (Epub ahead of print). doi: 10.1002/hep.25684.
  85. 85.
    Lehnert T, Herfarth C. Peptic ulcer surgery in patients with liver cirrhosis. Ann Surg. 1993;217:338–346.PubMedGoogle Scholar
  86. 86.
    Eidus LB, Rasuli P, Manion D, Heringer R. Caliber persistent artery of the stomach (Dieulafoy’s vascular malformation). Gastroenterology. 1990;90:1507–1510.Google Scholar
  87. 87.
    Pathan NF, El-Fanek H. A 70-year-old man with episodes of upper gastrointestinal bleeding. Dieulafoy lesion/malformation. Arch Pathol Lab Med. 2006;130:27–29.Google Scholar
  88. 88.
    Alshumrani G, Almuaikeel M. Angiographic findings and endovascular embolization in Dieulafoy disease: a case report and literature review. Diagn Interv Radiol. 2006;12:151–154.PubMedGoogle Scholar
  89. 89.
    Nga ME, Buhari SA, Iau PT, Raju GC. Jejunal Dieulafoy lesion with massive lower intestinal bleeding. Int J Colorectal Dis. 2007;22:1417–1418.PubMedGoogle Scholar
  90. 90.
    Jain R, Chetty R. Dielafoy disease of the colon. Arch Pathol Lab Med. 2009;133:1865–1867.PubMedGoogle Scholar
  91. 91.
    Ibanez A, Castro E, Fernandez E, et al. Clinical aspects and endoscopic management of gastrointestinal bleeding from Dieulafoy lesion. Rev Esp Enferm Dig. 2007;99:505–510.PubMedGoogle Scholar
  92. 92.
    Juler GL, Labitzke HG, Lamb R, Allen R. The pathogenesis of Dielafoy’s gastric erosion. Am J Gastroenterol. 1984; 79:195–200.Google Scholar
  93. 93.
    Broberg A, Ihre T, Pyke E, Raaschou-Nielson T. Exulceration simplex as conceivable cause of massive gastric hemorrhage. Surg Gynecol Obstet. 1982; 154:186–188.Google Scholar
  94. 94.
    Baxter M, Aly EH. Dieulafoy’s lesion: current trends in diagnosis and management. Ann R Coll Surg Engl. 2010;92:548–554.PubMedCentralPubMedGoogle Scholar
  95. 95.
    Akhras J, Patel P, Tobi M. Dieulafoy’s lesion-like bleeding: An underrecognized cause of upper gastrointestinal hemorrhage in patients with advanced liver disease. Dig Dis Sci. 2007;52:722–726.PubMedGoogle Scholar
  96. 96.
    Baettig B, Haecki W, Lammer F, Jost R. Dieulafoy’s disease: endoscopic treatment and follow up. Gut. 1993;34:1418–1421.PubMedGoogle Scholar
  97. 97.
    Mumtaz R, Shaukat M, Ramirez FC. Outcomes of endoscopic treatment of gastroduodenal Dieulafoy’s lesion with rubber band ligation and thermal/injection therapy. J Clin Gastroenterol. 2003;36:310–314.PubMedGoogle Scholar
  98. 98.
    Iacopini F, Petruzzielo L, Marchese M, et al. Hemostasis of Dieulafoy’s lesions by argon plasma coagulation. Gastrointest Endosc. 2007;66:20–26.PubMedGoogle Scholar
  99. 99.
    Mallory GK, Weiss S. Hemorrhages from laceration of cardia orifice of the stomach due to vomiting. Am J Med Sci. 1929;178:506–510.Google Scholar
  100. 100.
    Lecleire S, Di Fiore F, Merle V, et al. Acute upper gastrointestinal bleeding in patients with liver cirrhosis and in noncirrhotic patients: epidemiology and predictive factors of mortality in a prospective multicenter population-based study. J Clin Gastroenterol. 2005;39:321–327.PubMedGoogle Scholar
  101. 101.
    Di Fiore F, Lecleire S, Merle V, et al. Changes in characteristics and outcome of acute upper gastrointestinal haemorrhage: a comparison of epidemiology and practices between 1996 and 2000 in a multicentre French study. Eur J Gastroenterol Hepatol. 2005;17:641–647.PubMedGoogle Scholar
  102. 102.
    Penston JG, Boyd EJ, Wormsley KG. Mallory-Weiss tears occurring during endoscopy: a report of seven cases. Endoscopy. 1992;24:262.PubMedGoogle Scholar
  103. 103.
    Watts HD, Admirand WH. Mallory-Weiss syndrome. A reappraisal. JAMA. 1974;230:1674.PubMedGoogle Scholar
  104. 104.
    Harris JM, DiPalma JA. Clinical significance of Mallory–Weiss tears. Am J Gastroenterol. 1993;88:2056.PubMedGoogle Scholar
  105. 105.
    Michel L, Serrano A, Malt RA. Mallory-Weiss syndrome. Evolution of diagnostic and therapeutic patterns over two decades. Ann Surg. 1980;192:716.PubMedGoogle Scholar
  106. 106.
    Dagradi AE, Broderick JT, Juler G, Wolinsky S, Stempien SJ. The Mallory-Weiss syndrome and lesion. A study of 30 cases. Am J Dig Dis. 1966;11:710.PubMedGoogle Scholar
  107. 107.
    Sugawa C, Benishek D, Walt AJ. Mallory-Weiss syndrome. A study of 224 patients. Am J Surg. 1983;145:30.PubMedGoogle Scholar
  108. 108.
    Knauer CM. Mallory-Weiss syndrome. Characterization of 75 Mallory-Weiss lacerations in 528 patients with upper gastrointestinal hemorrhage. Gastroenterology. 1976;71:5.PubMedGoogle Scholar
  109. 109.
    Paquet KJ, Mercado-Diaz M, Kalk JF. Frequency, significance and therapy of the Mallory-Weiss syndrome in patients with portal hypertension. Hepatology. 1990;11:879–883.PubMedGoogle Scholar
  110. 110.
    Schuman BM, Threadgill ST. The influence of liver disease and portal hypertension on bleeding in Mallory-Weiss syndrome. J Clin Gastroenterol. 1994;18:10–12.PubMedGoogle Scholar
  111. 111.
    Fujisawa N, Inamori M, Sekino Y, et al. Risk factors for mortality in patients with Mallory-Weiss syndrome. Hepatogastroenterology. 2011;58:417–420.PubMedGoogle Scholar
  112. 112.
    Akhtar AJ, Padda MS. Natural history of Mallory-Weiss tear in African American and Hispanic patients. J Natl Med Assoc. 2011;103:412–415.PubMedGoogle Scholar
  113. 113.
    Kortas DY, Haas LS, Simpson WG, Nickl NJ 3rd, Gates LK Jr. Mallory-Weiss tear: predisposing factors and predictors of a complicated course. Am J Gastroenterol. 2001;96:2863–2865.PubMedGoogle Scholar
  114. 114.
    Park CH, Min SW, Sohn YH, et al. A prospective, randomized trial of endoscopic band ligation vs. epinephrine injection for actively bleeding Mallory-Weiss syndrome. Gastrointest Endosc. 2004;60:22–27.PubMedGoogle Scholar
  115. 115.
    Terada R, Ito S, Akama F, et al. Mallory-Weiss syndrome with severe bleeding: treatment by endoscopic ligation. Am J Emerg Med. 2000;18:812–815.PubMedGoogle Scholar
  116. 116.
    Higuchi N, Akahoshi K, Sumida Y, et al. Endoscopic band ligation therapy for upper gastrointestinal bleeding related to Mallory-Weiss syndrome. Surg Endosc. 2006;20:1431–1434.PubMedGoogle Scholar
  117. 117.
    Cho YS, Chae HS, Kim HK, et al. Endoscopic band ligation and endoscopic hemoclip placement for patients with Mallory-Weiss syndrome and active bleeding. World J Gastroenterol. 2008;14:2080–2084.PubMedGoogle Scholar
  118. 118.
    Lecleire S, Antonnieti M, Iwanicki-Caron I, et al. Endoscopic band ligation could decrease recurrent bleeding in Maallory-Weiss syndrome as compared to hemostasis by hemoclips plus epinephrine. Aliment Pharmacol Ther. 2009;30:399–405.PubMedGoogle Scholar
  119. 119.
    Ivekovic H, Rustemovic N, Brkic T, et al. The esophagus as a working channel: successful closure of a large Mallory-Weiss tear with clips and an endoloop. Endoscopy. 2011;43:E170.PubMedGoogle Scholar
  120. 120.
    Wright G, Lewis H, Hogan B, Burroughs A, Patch D, O’Beirne J. A self-expanding metal stent for complicated variceal hemorrhage: experience at a single center. Gastrointest Endosc. 2010;71:71–78.PubMedGoogle Scholar
  121. 121.
    De Palma G, Rega M, Masone S, et al. Mucosal abnormalities of the small bowel in patients with cirrhosis and portal hypertension: a capsule endoscopy study. Gastrointest Endosc. 2005;62:529–534.PubMedGoogle Scholar
  122. 122.
    Canlas KR, Dobozi BM, Lin S, et al. Using capsule endoscopy to identify GI tract lesions in cirrhotic patients with portal hypertension and chronic anemia. J Clin Gastroenterol. 2008;42:844–848.PubMedGoogle Scholar
  123. 123.
    Abdelaal UM, Morita E, Nouda S, et al. Evaluation of portal hypertensive enteropathy by scoring with capsule endoscopy: is transient elastography of clinical impact? J Clin Biochem Nutr. 2010;47:37–44.PubMedCentralPubMedGoogle Scholar
  124. 124.
    Higaki N, Matsui H, Imaoka H, et al. Characteristic endoscopic features of portal hypertensive enteropathy. J Gastroenterol. 2008;43:327–331.PubMedGoogle Scholar
  125. 125.
    Menchen L, Ripoll C, Marin-Jimenez I, et al. Prevalence of portal hypertensive duodenopathy in cirrhosis: clinical and hemodynamic features. Eur J Gastroenterol Hepatol. 2006;18:649–653.PubMedGoogle Scholar
  126. 126.
    Figueiredo P, Almeida N, Lerias C, et al. Effect of portal hypertension in the small bowel: an endoscopic approach. Dig Dis Sci. 2008;53:2144–2150.PubMedGoogle Scholar
  127. 127.
    Jimenez-Saenz M, Romero-Vazquez J, Caunedo-Alvarez A, Maldonado-Perez B, Herrerias Gutierrez JM. Beneficial effects and reversion of vascular lesions by thalidomide in a patient with bleeding portal hypertensive enteropathy. Dig Dis Sci. 2010;42:232–233.Google Scholar
  128. 128.
    Zhong J, Ma T, Zhang C, et al. A retrospective study of the application on double-balloon enteroscopy in 378 patients with suspected small bowel diseases. Endoscopy. 2007;39:208–215.PubMedGoogle Scholar
  129. 129.
    Pezzoli A, Fusetti N, Simone L, et al. Portal hypertensive enteropathy diagnosed by capsule endoscopy and demonstration of the ileal changes after transjugular intrahepatic portosystemic shunt placement: a case report. J Med Case Rep. 2011;5:90.PubMedCentralPubMedGoogle Scholar
  130. 130.
    Bresci G, Gambardella L, Parisi G, et al. Colonic disease in cirrhotic patients with portal hypertension: an endoscopic and clinical evaluation. J Clin Gastroenterol. 1998;26:222–227.PubMedGoogle Scholar
  131. 131.
    Baba HY, Hokotate H, Inoue H, Nakajo M. Correlations between colonic wall thickening in patients with virally induced cirrhosis on CT and clinical status. J Comput Assist Tomogr. 2001;25:786–791.PubMedGoogle Scholar
  132. 132.
    Misra SP, Dwivedi M, Misra V, Dharmani S, Kunwar BK, Arora JS. Colonic changes in patients with cirrhosis and in patients with extrahepatic portal vein obstruction. Endoscopy. 2005;37:454–459.PubMedGoogle Scholar
  133. 133.
    Kozarek RA, Botoman VA, Bredfeldt JE, Roach JM, Patterson DJ, Ball TJ. Portal colopathy: prospective study of colopathy in patients with portal hypertension. Gastroenterology. 1991;101:1192–1197.PubMedGoogle Scholar
  134. 134.
    Naveau S, Bedossa P, Poynard T, Mory B, Chaput JC. Portal hypertensive colopathy: a new entity. Dig Dis Sci. 1991;36:1774–1781.PubMedGoogle Scholar
  135. 135.
    Tam TN, Ng WW, Lee SD. Colonic mucosal changes in patients with liver cirrhosis. Gastrointest Endosc. 1995;42:408–412.PubMedGoogle Scholar
  136. 136.
    Bini EJ, Lascarides CE, Micale PL, Weinshel EH. Mucosal abnormalities of the colon in patients with portal hypertension: an endoscopic study. Gastrointest Endosc. 2000;52:511–516.PubMedGoogle Scholar
  137. 137.
    Ito K, Shiraki K, Sakai T, Yoshimura H, Nakano T. Portal hypertensive colopathy in patients with liver cirrhosis. World J Gastroenterol. 2005;11:3127–3130.PubMedGoogle Scholar
  138. 138.
    Bresci G, Parisi G, Capria A. Clinical relevance of colonic lesions in cirrhotic patients with portal hypertension. Endoscopy. 2006;38:830–835.PubMedGoogle Scholar
  139. 139.
    Chen LS, Lin HC, Lee FY, Hou MC, Lee SD. Portal hypertensive colopathy in patients with cirrhosis. Scand J Gastroenterol. 1996;31:490–494.PubMedGoogle Scholar
  140. 140.
    Diaz-Sanchez A, Nunez-Martinez O, Gonzalez-Asanza C, et al. Portal hypertensive colopathy is associated with portal hypertension severity in cirrhotic patients. World J Gastroenterol. 2009;15:4781–4787.PubMedGoogle Scholar
  141. 141.
    Yoshie K, Fujita Y, Moriya A, Kawana I, Miyamoto K, Umemura S. Octreotide for severe acute bleeding from portal hypertensive colopathy: a case report. Eur J Gastroenterol Hepatol. 2001;13:1111–1113.PubMedGoogle Scholar
  142. 142.
    Santoro GA, Aiello C, Galloro G, Savino N, Bucci L. Massive lower gastrointestinal hemorrhage in patients with portal hypertensive enteropathy: a report of two case. Hepatogastroenterology. 1997;44:1029–1032.PubMedGoogle Scholar
  143. 143.
    Rana SS, Dutta U, Sinha SK, Kochhar R, Nagi B, Bhasin DK. Severe acute bleeding from portal colopathy controlled by somatostatin. Trop Gastroenterol. 2004;25:144–145.PubMedGoogle Scholar
  144. 144.
    Bernard AC, Hagihara PF, Burke VJ, Kugelmas M. Endoscopic localization and management of colonic bleeding in patients with portal hypertension. Surg Laparosc Endosc Percutan Tech. 2001;11:195–198.PubMedGoogle Scholar
  145. 145.
    Ohta M, Hashizume M, Kishihara F, Kawanaka H, Tanoue K, Sugimachi K. Recurrent rectal bleeding from portal hypertensive colopathy in a patient with hemorrhoids. Am J Gastroenterol. 1995;90:1531–1533.PubMedGoogle Scholar
  146. 146.
    Balzer C, Lotterer E, Kleber G, Fleig WE. Transjugular intrahepatic portosystemic shunt for bleeding angiodysplasia-like lesions in portal hypertensive colopathy. Gastroenterology. 1998;115:167–172.PubMedGoogle Scholar
  147. 147.
    Ozgediz D, Devine P, Garcia-Aquilar J. Refractory lower gastrointestinal bleeding from portal hypertensive colopathy. J Am Coll Surg. 2008;207:613.PubMedGoogle Scholar
  148. 148.
    Misra SP, Dwivredi M, Misra V. Prevalence and factors influencing hemorrhoids, anorectal varices, and colopathy in patients with portal hypertension. Endoscopy. 1996;28:340–345.PubMedGoogle Scholar
  149. 149.
    Misra SP, Misra V, Dwivedi M. Effect of esophageal variceal band ligation on hemorrhoids, anorectal varices, and portal hypertensive gastropathy. Endoscopy. 2002;34:195–198.PubMedGoogle Scholar
  150. 150.
    Wang TF, Lee FY, Tsai YT, et al. Relationship of portal pressure, anorectal varices and hemorrhoids in cirrhotic patients. J Hepatol. 1992;15:170–173.PubMedGoogle Scholar
  151. 151.
    Rabinovitz M, Schade RR, Dindzans VJ, Belle SH, Van Thiel DH, Gavaler JS. Colonic disease in cirrhosis. An endoscopic evaluation in 412 patients. Gastroenterology. 1990;99:195–199.PubMedGoogle Scholar
  152. 152.
    Zaman A, Hapke R, Flora K, Rosen H, Benner K. Prevalence of upper and lower gastrointestinal tract findings in liver transplant candidates undergoing screening endoscopic evaluation. Am J Gastroenterol. 1999;94:895–899.PubMedGoogle Scholar
  153. 153.
    Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology. 1990;98:380–386.Google Scholar
  154. 154.
    Hegedus L, Ladocsi B, Wellner I, Olah A. New surgical method in the treatment of severe hemorrhoidal bleeding caused by decompensated liver cirrhosis. Megy Seb. 2001;54:52–53.Google Scholar
  155. 155.
    Huang WS, Lin PY, Chin CC, et al. Stapled hemorrhoidopexy for prolapsed hemorrhoids in patients with liver cirrhosis; a preliminary outcome for 8-case experience. Int J Colorectal Dis. 2007;22:1083–1089.PubMedGoogle Scholar
  156. 156.
    Zaher T, Ibrahim I, Ibrahim A. Endoscopic band ligation of internal hemorrhoids versus stapled hemorrhoidopexy in patients with portal hypertension. Arab J Gastroenterol. 2011;12:11–14.PubMedGoogle Scholar
  157. 157.
    Franco D, Deporte A, Darragon T, Bismuth H. Digestive tract hemorrhages of cirrhotic patients. Relation between hepatic insufficiency and the hemorrhagic lesion. Nouv Presse Med. 1975;4:2993–2996.PubMedGoogle Scholar
  158. 158.
    Teres J, Bordas JM, Bru C, Diaz F, Bruguera M, Rodes J. Upper gastrointestinal bleeding in cirrhosis: clinical and endoscopic correlations. Gut. 1976;17:37–40.PubMedGoogle Scholar
  159. 159.
    Hsieh WJ, Lin HC, Hwang SJ, et al. The effect of ciprofloxacin in the prevention of bacterial infection in patients with cirrhosis after upper gastrointestinal bleeding. Am J Gastroenterol. 1998;93:962–966.PubMedGoogle Scholar
  160. 160.
    Del Olmo JA, Pena A, Serra MA, Wassel AH, Benages A, Rodrigo JM. Predictors of morbidity and mortality after the first episode of upper gastrointestinal bleeding in liver cirrhosis. J Hepatol. 2000;32:19–24.PubMedGoogle Scholar
  161. 161.
    Odelowo O, Smoot D, Kim K. Upper gastrointestinal bleeding in patients with liver cirrhosis. J Natl Med Assoc. 2002; 9.Google Scholar
  162. 162.
    Vlachogiannakos J, Sklavos P, Viazis N et al. Long-term prognosis of cirrhotics with an upper gastrointestinal bleeding episode: Does infection play a role? J Gastroenterol Hepatol. 2008; 23:e438–e444.Google Scholar
  163. 163.
    Seo YS, Kim YH, Ahn SH, et al. Clinical features and treatment outcomes of upper gastrointestinal bleeding in patients with cirrhosis. J Korean Med Sci. 2008;23:635–643.PubMedCentralPubMedGoogle Scholar
  164. 164.
    Thabut D, D’Amico G, Tan P, et al. Diagnostic performance of Baveno IV criteria in cirrhotic patients with upper gastrointestinal bleeding: analysis of the F7 liver-1288 study population. J Hepatol. 2010;53:1029–1034.PubMedGoogle Scholar
  165. 165.
    Svoboda P, Ehrmann J, Klvana P, Machytka E, Rydlo M, Hrabovsky V. A different view of acute upper gastrointestinal bleeding in liver cirrhosis patients. Vnitr Lek. 2010;56:1116–1121.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • M. Kalafateli
    • 1
  • C. K. Triantos
    • 1
    • 3
    Email author
  • V. Nikolopoulou
    • 1
  • A. Burroughs
    • 2
  1. 1.Department of GastroenterologyUniversity Hospital of PatrasPatrasGreece
  2. 2.The Royal Free Sheila Sherlock Liver Centre and University Division of Surgery Royal Free Hospital, University College LondonLondonUK
  3. 3.PatrasGreece

Personalised recommendations