Original Research

Frequency of Gastroesophageal Variceal Bleeding In Cirrhotic Patients with and without Diabetes

Hafiz Irfan Mushtaq
Department of Medicine & Gastroenterology Services Institute of Medical Science, Services Hospital Lahore
Muhammad Arif Nadeem
Department of Medicine & Gastroenterology Services Institute of Medical Science, Services Hospital Lahore
Tabish Sarwar
Department of Medicine & Gastroenterology Services Institute of Medical Science, Services Hospital Lahore
Muhammad Naeem Afzal
Department of Medicine & Gastroenterology Services Institute of Medical Science, Services Hospital Lahore
Shahid Sarwar
Department of Medicine & Gastroenterology Services Institute of Medical Science, Services Hospital Lahore

✉ Correspondence: Muhammad Arif Nadeem Email: arifnadeem1234@gmail.com

DOI https://doi.org/10.70302/jpsim.v1i1.2014
Volume: 1, Issue 1 Pages: 60–66 Published: 16 Dec 2020
Received: 27 Sep 2020 Accepted: 11 Oct 2020 Published Online: 16 Dec 2020

Abstract

Objectives

The objectives were to establish the frequency of diabetes in cirrhotic patients presenting to Services Hospital Lahore and to compare the frequency of GEVB in cirrhotic patients with and without diabetes.

Methods

It was a cross-sectional study, conducted at Department of Medicine Unit-III, Services Hospital, Lahore from 22/12/2016 to 21/06/2017. This study involved 134 patients of both genders aged between 25-65 years diagnosed of cirrhosis at least a year ago. These patients were assessed for the presence of diabetes and gastroesophageal variceal bleed. Frequency of GEVB was compared among cirrhotic patients with and without diabetes.

Results

Mean age of the patients was 53.51±8.53 years, and majority were aged between 51-65 years (61.2%) and 35-50 years (38.8%). There were 80 (59.7%) male and 54 (40.3%) female patients in the study group with a male to female ratio of 1.5:1. The mean duration of cirrhosis was 23.73±10.24 months. 48 (35.8%) patients had Hepatitis B while 86 (64.2%) patients had Hepatitis C on viral serology. Diabetes was diagnosed in 46 (34.3%) patients with cirrhosis. We observed no significant difference in the frequency of diabetes according to age (p=0.751), gender (p=0.842), duration of disease (p=0.864) and serological (p=0.856) groups. Gastroesophageal variceal bleeding was seen in 20 (14.9%) patients with significantly high frequency with diabetes (28.3% vs. 8.0%; p=0.002) as compared to without. Similar significant difference was observed across all age, gender, duration of disease and serological groups.

Conclusion

The frequency of diabetes was 34.3% among cirrhotic patients and of gastroesophageal variceal bleeding was significantly higher among them with diabetes (28.3% vs. 8.0%; p=0.002) as compared to those without regardless of age, gender, duration of cirrhosis and viral serology.

Keywords
Cirrhosis Diabetes Gastroesophageal Variceal Bleeding

How to Cite This Article

Mushtaq HI, Nadeem MA, Sarwar T, Afzal MN, Sarwar S. Frequency of Gastroesophageal Variceal Bleeding In Cirrhotic Patients with and without Diabetes. J Pak Soc Intern Med. 2020;1(1):60–66. doi:10.70302/jpsim.v1i1.2014

⭳ Download PDF

Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

References

  1. Jepsen P. Comorbidity in cirrhosis. World J Gastroenterol 2014; 20(23):7223-30.
  2. Garcia-Compean D, Jaquez-Quintana JO, Gonzalez-Gonzalez JA, Maldonado-Garza H. Liver cirrhosis and diabetes: risk factors, pathophysiology, clinical implications, and management. World J Gastroenterol 2009; 15(3):280-8.
  3. Majid S, Azam Z, Shah HA, Salih M, Hamid S, Abid S, et al. Factors determining the clinical outcome of acute variceal bleed in cirrhotic patients. Indian J Gastroenterol 2009; 28(3):93-5.
  4. Yang CH, Chiu YC, Chen CH, Chen CH, Tsai MC, Chuah SK, et al. Diabetes mellitus is associated with gastroesophageal variceal bleeding in cirrhotic patients. Kaohsiung J Med Sci 2014; 30(10):515-20.
  5. Jeon HK, Kim MY, Baik SK, Park HJ, Choi H, Park SY, et al. Hepatogenous diabetes in cirrhosis is related to portal pressure and variceal hemorrhage. Dig Dis Sci 2013; 58(11):3335-41.
  6. Gadoa A, Ebeidb B, Abdelmohsenc A, Axond A. Predictors of mortality in patients with acute upper gastrointestinal hemorrhage who underwent endoscopy and confirmed to have variceal hemorrhage. Alexandria J Med 2015; 51(4):295-304.
  7. Zein NN, Abdulkarim AS, Wiesner RH, Egan KS, Persing DH. Prevalence of diabetes mellitus in patients with end stage liver cirrhosis due to hepatitis C, alcohol, or cholestatic disease. J Hepatol 2000; 32(2):209­17.
  8. Kwon SY. Prevalence and clinical significance of diabetes mellitus in patients with liver cirrhosis. Korean J Hepatol 2003; 9(3):205-11.
  9. Alavian SM, Hajarizadeh B, Nematizadeh F, Larijani B. Prevalence, and determinants of diabetes mellitus among Iranian patients with chronic liver disease. BMC Endocr Disord 2004; 4(1):4.
  10. Sigal S, Stanca C, Kontorinis N, Bodian C, Ryan E. Diabetes mellitus is associated with hepatic encephalopathy in patients with hcv cirrhosis. Am J Gastroenterol 2006; 101(7):1490-6.
  11. Quintana JO, García-Compean D, González JA, Pérez JZ, González FJ, Espinosa LE, et al. The impact of diabetes mellitus in mortality of patients with compensated liver cirrhosis-a prospective study. Ann Hepatol 2011; 10(1):56-62.
  12. Saleem S, Zaib J, Malik IH. Frequency of type 2 diabetes mellitus in patients with cirrhosis associated with chronic hepatitis c virus infection. Pak J Med Health Sci 2013; 7(1):18-21.
  13. Memon MS, Arain ZI, Naz F, Zaki M, Kumar S, Burney AA. Prevalence of type 2 diabetes mellitus in hepatitis C virus infected population: A Southeast Asian study. J Diabetes Res 2013; https://doi.org/10.1155/2013/539361. doi:10.1155/2013/539361
  14. Ennaifer R, Cheikh M, Hefaiedh R, Romdhane H, Nejma HB, Hadj NB. Glucose metabolism disorders in cirrhosis: frequency and risk factors in Tunisian population. Results of a cross-sectional study. Open J Gastroenterol 2014; 4(8):289-94.
  15. Kalar MU, Ali AA, Ali S, Hasan SM, Kazmi SJ. Frequency of diabetes in Hepatitis. Int J Collab Res Intern Med Pub Health 2014; 6(7):226-34.
  16. Raff EJ, Kakati D, Bloomer JR, Shoreibah M, Rasheed K, Singal AK. Diabetes mellitus predicts occurrence of cirrhosis and hepatocellular cancer in alcoholic liver and non-alcoholic fatty liver diseases. J Clin Transl Hepatol 2015; 3(1):9-16.
  17. Hu LF, Xu XH, Zhou ZS, Chen GS, Ying HF, Ye Y, et al. Role of diabetes mellitus in liver cirrhosis in the Anhui region of China. Open Access Lib J 2015; 2(11): e2101.
  18. Arshad MF, Butt Z, Mushtaq K, Salaria O. Impact of diabetes mellitus on frequency and severity of hepatic encephalopathy in liver cirrhosis. Endo Abs 2016; DOI: 10.1530/endoabs.44. P102. doi:10.1530/endoabs.44
  19. Khafaga S, Khalil K, Abdou M, Miada M, Shedid M, Mosaad M. Acute variceal bleeding in patients with liver cirrhosis with and without diabetes. Liver Res Open J 2015; 1(1):14-20.
  20. Almani SA, Memon AS, Memon AI, Shah I, Rahpoto Q, Solangi R. Cirrhosis of liver: Etiological factors, complications, and prognosis. J Liaquat Uni Med Health Sci 2008; 7(2):61-6.
  21. Ali M, Abbas SZ, Sultana F, Akhtar W, Shaw S, Abbas SQ. Non-B, Non-C Hepatitis as a cause of Advanced Chronic Liver Disease requiring medical admission at a rural centre in Pakistan. Pak J Med Sci 2008; 24(2):278-82.
  22. Achakzai MS, Shaikh H, Mobbing A, Majid S, Javed A, Khalid AB, et al. Factors leading to hepatic encephalopathy in patients with liver cirrhosis at a tertiary care hospital in Karachi, Pakistan Gomal J Med Sci 2016;14(2):71-4.
  23. Hussain A, Nadeem MA, Nisar S, Tauseef HA. Frequency of gallstones in patients with liver cirrhosis. J Ayub Med Coll Abbott 2014; 26(3):341-3.
  24. Penteado KR, Coelho JC, Parolin MB, Matias JE, Freitas AC. The influence of end-stage liver disease and liver transplantation on thyroid hormones. Arq Gastroenterol 2015; 52(2):124-8.
  25. Mansour-Ghanaei F, Mehrdad M, Mortazavi S, Joukar F, Khak M, Atrkar-Roushan Z. Decreased serum total T3 level in hepatitis B and C related cirrhosis by severity of liver damage. Ann Hepatol 2012; 11(5):667-71.
  26. Tariq M, Ahad W, Tahir M, Ahmed A, Shafique HM. Frequency of hepatocellular carcinoma in cirrhotic patients with hepatitis-C virus positive patients in Karachi-Pakistan. Int J Res Med Sci 2015; 3(7):1594-8.
  27. Bhattacharyya M, Barman NN, Goswami B. Clinical profile of cirrhosis of liver in a tertiary care hospital of Assam, North East India. IOSR J Dent Med Sci 2016; 5(1):21-7.
  28. Deepika G, Veeraiah N, Rao PN, Reddy DN. Prevalence of hypothyroidism in liver cirrhosis among Indian patients. Int J Pharm Med Res 2015; 3(3):4-7.
  29. Mousa HA, Elzein HO, NassrEldin MAS, Elzein AO. Serum thyroid hormone levels in Sudanese patients with liver cirrhosis. OSR J Pharm Biol Sci 2016; 11(6):14-8.
  30. Anastasiou O, Sydor S, Sowa JP, Manka P, Katsounas A, Syn WK, et al. Higher thyroid-stimulating hormone, triiodothyronine and thyroxine values are associated with better outcome in acute liver failure. PLoS ONE 2015; 10(7): e0132189.
  31. El-Feki MAF, Abdalla NH, Atta MI, Ibrahim AA. Serum level of thyroid hormones in patients with chronic hepatitis c virus infection. Open J Endocr Metab Dis 2016; 6(3):126-34.
  32. El-Kabbany Z, Rasha TH, Abd El Hakim AS, Lamis MT. Thyroid and hepatic haemodynamic alterations among Egyptian children with liver cirrhosis. ISRN Gastroenterol 2012; https://doi.org/10.5402/2012/595734. doi:10.5402/2012/595734

Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2020 Journal of Pakistan Society of Internal Medicine.
📃 In This Issue View All
Original Article Cervical Cancer Screening Awareness Among Rural Women in Punjab Bibi S, Anjum R, Hassan F Review Article Statin Therapy in Non-Alcoholic Fatty Liver Disease: A Systematic Review Nawaz F, Cheema HA, Mehmood Y Original Article Neonatal Sepsis: Bacteriological Profile and Antibiogram in a Tertiary Care Hospital Iqbal M, Rashid T Original Article Impact of Diabetes Mellitus on Post-Operative Wound Healing in General Surgery Siddiqui FA, Noor M, Akhtar W Original Article Outcomes of Laparoscopic Cholecystectomy in Acute Cholecystitis: A Retrospective Analysis Raza SH, Butt N, Qureshi AM
👥 More by These Authors
Original Article Comparison of Ultrasound-Guided versus Landmark-Based Central Venous Catheter Insertion Zafar S, Gillani SA Original Article Prevalence of Hypertension Among Urban Adults in Pakistan: A Cross-Sectional Study Khan TM, Ahmed S, Malik RA Review Article Thyroid Disorders in Pregnancy: Clinical Implications and Management Strategies Baig BI, Usman A Original Article Serum Ferritin as a Prognostic Marker in COVID-19 Severity: A Hospital-Based Study Rehman N, Sheikh I, Javed K
🔗 Related Articles By Keywords
Original Article Neonatal Sepsis: Bacteriological Profile and Antibiogram in a Tertiary Care Hospital Iqbal M, Rashid T Original Article Impact of Diabetes Mellitus on Post-Operative Wound Healing in General Surgery Siddiqui FA, Noor M, Akhtar W Original Article Outcomes of Laparoscopic Cholecystectomy in Acute Cholecystitis: A Retrospective Analysis Raza SH, Butt N, Qureshi AM Review Article Antibiotic Resistance Patterns in Community-Acquired Pneumonia: Emerging Trends Hussain I, Farooq Z