Variceal bleeding is one of the major complications of portal hypertension. Gastro-esophageal varices are present 40-60% of patients with cirrhosis; bleeding occurs in 25-35% of patients and account for 80-90% of bleeding episodes in these patients. Hepatic venous pressure gradient (HVPG) > 20 mmHg is associated with early re-bleed and failure to control bleeding (83%) with high mortality (64%) In the last two decades variceal re-bleeding has decreased from 47% to 13% with the use of pharmacological, endoscopic, and radiological intervention.DM co-existing with cirrhosis is considered to be one of the factors in the genesis of variceal bleeding. This may be due to an increase in portal blood flow. is to determine the correlation between DM as a risk factor and failure to control variceal bleeding and re-bleeding in cirrhotic patients. This study is a case-control study, sixty cirrhotic patients with variceal bleeding with or without DM were included in the study. The patients were divided into two groups: Group 1 (diabetic group): this group included 30 cirrhotic patients with variceal bleeding and had a history of DM. Group 2 (control group): this group included 30 cirrhotic patients with variceal bleeding and had no history of DM. All Patients were subjected to the following:-Complete clinical evaluation (history and physical examination) with Laboratory and imaging investigations. Tthere were significantly higher frequency of unstable course and mean times of previous admission in diabetic patients than control patients (73.3% and 1.6 times versus 36.6% and 1.3 times, respectively). Other variables showed insignificant differences between both groups (p>0.05). There were significantly higher mean numbers of attacks of hematemesis and melena and times of previous admission with these attacks in diabetic patients than control patients
___
1. Monescillo A, Martinez-Lagares F, Ruiz-del-Arbol L, Sierra A, Guevara C, Jiménez E, Marrero JM, Buceta E, Sánchez J, Castellot A, Peñate M, Cruz A, Peña E. Influence of portal hypertension and its early decompression by TIPS Placement on the outcome of variceal bleeding. Hepatology. 2004;40(4):793-801.
2. McCormick PA, O’Keefe C. Improving prognosis following a first variceal haemorrhage over four decades. Gut. 2001;49(5):682-5.
3. Imano E, Kanda T, Nakatani Y, Motomura M, Arai K, Matsuhisa M, Yamasaki Y, Hori M. Impaired splanchnic and Peripheral glucose uptake in liver cirrhosis. J Hepatol. 1999;31(3):469-73.
4. Carbonell N, Pauwels A, Serfaty. L, Fourdan O, Lévy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 2004;40(3):652-9.
5. Moreau R, Chagneau C, Heller J, Chevenne D, Langlet P, Deltenre P, Hillaire S, Lefilliatre P, Pateron D, Sogni P, Valla D, Lebrec D. Hemodynamic, metabolic and hormonal responses to oral glibenclamide in patients with cirrhosis receiving glucose. Scand J Gastroenterol. 2001;36(3):303-8.
6. Bianchi G, Marchesini G, Zoli M, Bugianesi E, Fabbri A, pisi E. Prognostic significance of diabetes in patients with cirrhosis Hepatology. 1994;20(1Pt1):119-25.
7. Kondo F, Ebara M, Sugiura N, Wada K, Kita K, Hirooka N, Nagato Y, Kondo Y, Ohto M, Okuda K. Histological features and clinical course of large regenerative nodules: evaluation of their precancerous potential. Hepatology. 1990;12(3Pt1:592-8.
8. Schalm SW. The diagnosis of cirrhosis: clinical relevance and methodology. J. Hepatol. 1997;27(6):1118-9.
9. Paquet KJ. Causes and pathomechanisms of oesophageal varices development. Med Sci Monit. 2000;6(5):915-28.
10. Kitada T, Seki S, Ikeda K, Nakatani K, Sakaguchi H, Kawada N, Kadoya H, Kaneda K. Clinicopathological characterization of prion: a novel marker of activated human hepatic stellate cells. J. Hepatol. 2000;33(5):751.
11. Sarin SK, Kumar A. Gastric varices: profil, classification, and management. Am J Gastroenterol. 1989;84(10):1244-9.
12. Puri P, Sanyal AJ. Role of obesity, insulin resistance, and steatosis in hepatitis C virus infection. Clin Liver Dis. 2006;10(4):793–819
13. Maeno T, Okumura A, Ishikawa T, Kato K, Sakakibara F, Sato K, Ayada M, Hotta N, Tagaya T, Fukuzawa Y, Kakumu S. Mechanisms of increased insulin resistance in non-cirrhotic patients with chronic hepatitis C virus infection. J Gastroenterol Hepatol. 2003;18(12):1358–63.
14. Weinman SA, Belalcazar LM. Hepatitis C: a metabolic liver disease. Gastroenterology. 2004;126(3):917–9.
15. El-Serag HB, Everhart JE. Diabetes increases the risk of acute hepatic failure. Gastroenterology. 2002;122(7):1822-8.
16. Cammà C, Petta S, Di Marco V, Bronte F, Ciminnisi S, Licata G, Peralta S, Simone F, Marchesini G, Craxì A. Insulin resistance is a risk factor for esophageal varices in hepatitis C virus cirrhosis. Hepatology. 2009;49(1):195–203.
17. Neuschwander-Tetri BA, Caldwell SH. Nonalcoholic steatohepatitis: summary of an AASLD single topic conference. Hepatology. 2003;37(5):1202–19.
18. Wisner E, Zwingenberger A. What do hyperechoic and hypoechoic mean: Atlas of Small Animal CT and MRI. 1st edition. Wiley Blackwell & Son, Inc, 2007.
19. Tang CP, Huang YS, Tsay SH, Chang FY, Lee SD. Nonalcoholic Fatty Liver Disease Manifesting Esophageal Variceal Bleeding. J Chin Med Assoc. 2006; 69(4):175–8.
20. Elbaih AH, Ismail MT, Elgwad EEA, Hassan F, Helmy A. Detection of medical errors in management of traumatic hypovolemic shocked adult patients presented to emergency department in Suez Canal University Hospital, Ismailia, Egypt. Int Surg J. 2016; 3(2): 882-6.