Does gastroesophageal reflux have an influence on bleeding from esophageal varices?
BACKGROUND
Mucosal breaks induced by gastroesophageal reflux of gastric contents were more frequently found on the right anterior wall of the lower esophagus. Bleeding from esophageal varices may be also derived from gastroesophageal reflux. The circumferential location of the ruptured esophageal varices was evaluated to elucidate the relationship between gastroesophageal reflux and variceal rupture.


METHODS
Between January 2004 and December 2006, 26 patients who had primary bleeding from esophageal varices and 74 patients without evidence of bleeding with positive red color signs on varices were enrolled in this study retrospectively. Locations of bleeding spots and nonbleeding red color signs of esophageal varices were retrospectively evaluated by endoscopic photographs, and the relationship between the location of red color signs and the risk of bleeding was evaluated. Other possible predictors for bleeding were also investigated by multivariate regression analysis.


RESULTS
Red color signs were frequently found in the right posterior wall of the lower esophagus. However, bleeding spots of esophageal varices were more frequently seen in the right anterior side (64.0%) than in others. The positive predictor for bleeding from esophageal varices was the presence of red color sign in the right anterior wall of the esophagus, and the administration of proton pomp inhibitor was the negative predictor.


CONCLUSIONS
Gastroesophageal acid reflex may be a risk factor of bleeding from esophageal varices. Attention should be paid to the circumferential location of red color signs in endoscopic screening of patients with esophageal varices to predict future bleeding.
Okamoto
Eisuke
E
Department of Gastroenterology and Hepatology, Shimane University, School of Medicine, Izumo, Japan.
Amano
Yuji
Y
Fukuhara
Hiroyuki
H
Furuta
Koichiro
K
Miyake
Tatsuya
T
Sato
Shuichi
S
Ishihara
Shunji
S
Kinoshita
Yoshikazu
Y
D000368:Aged; D015331:Cohort Studies; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000473:pathology* / Q000628:therapy; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000473:pathology* / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors
D054328:Proton Pump Inhibitors