Impact of peptic ulcer bleeding on the in-hospital outcomes of cirrhotic patients with acute gastrointestinal bleeding: an international multicenter study

ABSTRACT

Objectives

Peptic ulcer is the most common source of non-variceal bleeding. However, it remains controversial whether the outcomes of cirrhotic patients with peptic ulcer bleeding differ from those with variceal bleeding.

Methods

Cirrhotic patients with acute gastrointestinal bleeding (AGIB) who underwent endoscopy and had an identifiable source of bleeding were retrospectively screened from an international multicenter cohort. Logistic regression analyses were performed to explore the impact of peptic ulcer bleeding on in-hospital death and 5-day failure to control bleeding. Propensity score matching (PSM) analysis was performed by matching age, gender, Child-Pugh score, and model for end-stage liver disease score between the peptic ulcer bleeding and variceal bleeding groups.

Results

Overall, 1535 patients were included, of whom 73 (4.7%) had peptic ulcer bleeding. Multivariate logistic regression analyses showed that peptic ulcer bleeding was not independently associated with in-hospital death (OR = 2.169, p = 0.126) or 5-day failure to control bleeding (OR = 1.230, p = 0.680). PSM analyses demonstrated that both in-hospital mortality (9.7% vs. 6.3%, p = 0.376) and rate of 5-day failure to control bleeding (6.9% vs. 5.4%, p = 0.787) were not significantly different between the two groups.

Conclusions

The impact of peptic ulcer bleeding on the in-hospital outcomes of cirrhotic patients is similar to that of variceal bleeding.

Clinical trial registration

NCT04662918

Plain Language Summary

In this international multicenter study, we included 1535 patients with acute gastrointestinal bleeding (AGIB) and divided them into peptic ulcer bleeding and variceal bleeding groups. We found that only a minority of AGIB episodes in cirrhotic patients was attributed to peptic ulcer. Additionally, after adjusting for the severity of liver dysfunction, the in-hospital mortality and the rate of 5-day failure to control bleeding should be similar between cirrhotic patients with peptic ulcer bleeding and those with variceal bleeding.

GRAPHICAL ABSTRACT

KEYWORDS:

• Liver cirrhosis
• gastrointestinal bleeding
• peptic ulcer
• variceal bleeding
• prognosis

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or mending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have received an honorarium for their review work. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Author contributions

Conceptualization: Xingshun Qi; Methodology: Yuhang Yin and Xingshun Qi; Validation: Yuhang Yin, Lei Liu, Bimin Li, Su Lin, Fanpu Ji, Fernando Gomes Romeiro, Mingyu Sun, Qiang Zhu, Dapeng Ma, Shanshan Yuan, Yingli He, Xiaofeng Liu, Cyriac Abby Philips, Nahum Méndez-Sánchez, Metin Basaranoglu, Kanokwan Pinyopornpanish, Yiling Li, Yunhai Wu, Yu Chen, Ling Yang, Lichun Shao, Andrea Mancuso, Frank Tacke, and Xingshun Qi;

Formal analysis: Yuhang Yin and Xingshun Qi; Investigation: Yuhang Yin, Lei Liu, Bimin Li, Su Lin, Fanpu Ji, Fernando Gomes Romeiro, Mingyu Sun, Qiang Zhu, Dapeng Ma, Shanshan Yuan, Yingli He, Xiaofeng Liu, Cyriac Abby Philips, Nahum Méndez-Sánchez, Metin Basaranoglu, Kanokwan Pinyopornpanish, Yiling Li, Yunhai Wu, Yu Chen, Ling Yang, Lichun Shao, Andrea Mancuso, Frank Tacke, and Xingshun Qi; Data curation: Yuhang Yin, Lei Liu, Bimin Li, Su Lin, Fanpu Ji, Fernando Gomes Romeiro, Mingyu Sun, Qiang Zhu, Dapeng Ma, Shanshan Yuan, Yingli He, Xiaofeng Liu, Cyriac Abby Philips, Nahum Méndez-Sánchez, Metin Basaranoglu, Kanokwan Pinyopornpanish, Yiling Li, Yunhai Wu, Yu Chen, Ling Yang, Lichun Shao, Andrea Mancuso, and Xingshun Qi; Writing–original draft: Yuhang Yin and Xingshun Qi;

Writing–review and editing: Yuhang Yin, Lei Liu, Bimin Li, Su Lin, Fanpu Ji, Fernando Gomes Romeiro, Mingyu Sun, Qiang Zhu, Dapeng Ma, Shanshan Yuan, Yingli He, Xiaofeng Liu, Cyriac Abby Philips, Nahum Méndez-Sánchez, Metin Basaranoglu, Kanokwan Pinyopornpanish, Yiling Li, Yunhai Wu, Yu Chen, Ling Yang, Lichun Shao, Andrea Mancuso, Frank Tacke, and Xingshun Qi; Supervision: Xingshun Qi; Project administration: Xingshun Qi. All authors have made an intellectual contribution to the manuscript and approved the submission.

Additional information

Funding

This paper was funded by the Outstanding Youth Foundation of Liaoning Province (2022-YQ-07).