Researchers have identified a unique GI bleeding syndrome associated with cirrhosis and portal hypertension, which they call “acute on chronic GI bleeding.”
The syndrome is “characterized by a typical presentation with acute bleeding (hematemesis, melena, or hematochezia) and also by the presence of chronic GI bleeding manifested by iron deficiency anemia,” Don C. Rockey, MD, chair of the department of medicine and professor of gastroenterology at the Medical University of South Carolina, and colleagues wrote. Patients with this syndrome show “different clinical characteristics than those with typical acute or chronic GI bleeding,” they added.
Rockey and colleagues prospectively evaluated all patients who had endoscopy for GI bleeding at Parkland Memorial Hospital in Dallas Texas from 2006 through 2011, including 776 with acute bleeding, 254 with chronic bleeding and 430 with acute on chronic bleeding.
They found that lesions in patients with acute on chronic GI bleeding occurred more commonly in the esophagus (28%), the colon and rectum (27%) and the stomach (21%) compared with those in patients with acute bleeding or chronic bleeding (P < .0001).
In the 260 patients with acute on chronic upper GI bleeding, portal hypertensive lesions were more commonly the cause of bleeding (47%) compared with patients with acute (29%) or chronic (25%) bleeding (P < .001).
“While virtually any lesion may cause acute on chronic bleeding, portal hypertensive lesions of the upper GI tract (with portal hypertensive enteropathy/gastropathy causing chronic bleeding, and varices causing acute bleeding) were the most common causes of this type of bleeding,” Rockey and colleagues wrote.
Notably, all patients with acute on chronic bleeding showed lower 30-day mortality compared with patients who had acute bleeding alone (2% vs. 7%; P < .001), which “raises the possibility of an adaptive response,” Rockey and colleagues noted.
“Our findings suggest that many patients assessed for acute GI bleeding also have an underlying chronic component of bleeding that frequently goes unrecognized,” they concluded, adding that “clinicians should be aware of the association of this presentation with cirrhosis and portal hypertension [as] this knowledge will influence differential diagnosis, and approach to evaluation.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.