In cirrhotic patients variceal bleeding is more frequent in the evening and correlates with severity of liver disease

BACKGROUND/AIMS: It has been observed that the portal pressure in cirrhotic patients shows circadian variation and is at a maximum at night. Our aims in this study were a) to evaluate the frequency of upper gastrointestinal ( UGI) bleeding from esophageal/gastric varices or portal congestive gastropa thy during the day, evening or night shift, and b) to correlate the frequen cy of bleeding during various shifts with severity of liver disease. METHODOLOGY: At our institution, during the period from January 1977 to Jun e 1995, 15,000 gastrointestinal (GI) endoscopic reports and consultations w ere evaluated. Episodes of bleeding due to portal hypertension (PH), i.e., esophageal varices, gastric varices or congestive gastropathy, were noted. The time of occurrence of bleeding from PH in various shifts, e.g., day shi ft (DS), evening shift (ES) or night shift (NS) was determined. The severit y of liver disease was classified as A, B or C according to Child's classif ication. RESULTS: There were 221 episodes of UGI bleeding due to PH in 144 patients. 75.5% of patients presented with hematemesis, whereas 24.5% presented with melena (p<0.025). Bleeding started during the DS in 39/221 (17.6%), during the ES in 122/221 (55.2%), and during the NS in 60/221 (27.1%), There were 29 (13.1%) patients in Child's A, 75 (33.9%) in Child's B, and 117 (52.9%) in Child's C. Among the 122 bleeders during ES, 85 (69.6%) were in categor y C. It seems that in these patients UGI bleeding is more frequent during t he ES compared to DS and NS (p<0.0001; chi square; 95%CI: 0.52-0.58), Child 's C patients are more likely to bleed during ES compared to Child's A or B patients (p<0.0001; Odds Ratio: 4.8%; 95%CI: 2.7-8.5). CONCLUSIONS: 1) The majority of the cirrhotic patients with PH who develop UGI bleeding present with hematemesis rather than melena. 2) The bleeding i n these patients is more likely to occur during the ES. 3) Child's C patien ts are more likely to bleed during the ES.