title: Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Keishi Komori, Masaru Kubokawa, Kazuya Akahoshi, Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan.
authors.forename: Keishi
authors.initials: K
authors.lastname: Komori
authors.affiliation: Keishi Komori, Masaru Kubokawa, Kazuya Akahoshi, Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kubokawa
authors.affiliation: Keishi Komori, Masaru Kubokawa, Kazuya Akahoshi, Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan.
authors.forename: Eikichi
authors.initials: E
authors.lastname: Ihara
authors.affiliation: Keishi Komori, Masaru Kubokawa, Kazuya Akahoshi, Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Akahoshi
authors.affiliation: Keishi Komori, Masaru Kubokawa, Kazuya Akahoshi, Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Keishi Komori, Masaru Kubokawa, Kazuya Akahoshi, Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Motomura
authors.affiliation: Keishi Komori, Masaru Kubokawa, Kazuya Akahoshi, Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan.
authors.forename: Akihide
authors.initials: A
authors.lastname: Masumoto
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000188:drug therapy*; D006528:Carcinoma, Hepatocellular / Q000150:complications*; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000401:mortality; D005260:Female; D005748:Gastric Fundus / Q000473:pathology; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D054328:Proton Pump Inhibitors
keywords: Antibiotics; Gastric fundus; Gastric varices; Hemorrhage; Proton pump inhibitors