Frequency of fundal varices in cirrhotic patients with upper gastrointestinal bleed.

Abstract

Objectives: Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency in cirrhosis. These patients mainly bleed from esophageal varices. The aim of the present work was to determine the prevalence of fundal varices; gastro-oesophageal varices type2 (GOV-2) and isolated gastric varices type1 (IGV-1), as a cause of AUGIB. Study Design: Cross-sectional study. Setting: Gastroenterology Department of Nishtar Hospital Multan, Pakistan, using non-probability consecutive sampling. Period: July to December 2018. Material and Methods: Emergency upper gastrointestinal (UGI) endoscopy was performed in 165 cirrhotic patients and the findings documented. Results: The mean age was 50.15 ± 12.72 years. There were 103 (62.4%) males and 62 (37.6%) females (p<0.0001). Hepatitis C virus (HCV) was the cause of cirrhosis in 75%, followed by HBV in 10% and HBV & HCV co-infection in 6%. Bleeding fundal varices were found in 25 (15%) patients, 15 IGV-1 and 10 GOV-2. Other major causes of bleeding included: esophageal varices 93 (56.4%) and portal hypertensive gastropathy (PHG) 33 (20%). All fundal varices were found in advanced liver disease patients (p<0.05). Conclusion: AUGIB is more common in males and advance liver disease. Although not frequent, fundal varices are an important cause of AUGIB, with a strong association with severity of cirrhosis. Our study demonstrates a higher prevalence of fundal varices (especially IGV-1) than other studies.