Diurnal Variation of Variceal Bleeding in Patients with Liver Cirrhosis

Kim, Kyung A; Woo, Gwang Hoon; Yoon, Jung Hwan; Lee, Hyo Suk; Kim, Chung Yong

Abstract

BACKGROUND/AIMS
Recognition of diurnal variation in clinical disorders helps uncover a pathophysiological mechanism and establish treatment strategies. The aim of this study was to investigate the features of upper gastrointestinal bleeding in patients with liver cirrhosis and assess diurnal variation of variceal bleeding.
METHODS
Medical records of patients with liver cirrhosis who had visited Seoul National University Hospital for hematemesis or melena from January 1990 to December 1997 were reviewed.
RESULTS
There were 345 episodes of upper gastrointestinal bleeding in 249 patients. Among them, 252 episodes (73%) presented with hematemesis and 93 episodes (27%) presented with melena. Causes of bleeding were variceal rupture in 258 episodes (74.8%), portal hypertensive gastropathy in 19 episodes (5.6%) and peptic ulcer in 28 episodes (8.3%). Occurrence rate of hematemesis due to variceal rupture varied with the lapse of time. Namely, 14.2% of them occurred between 2 and 6 o'clock, 11.0% between 6 and 10 o'clock, 11.0% between 10 and 14 o'clock, 16.1% between 14 and 18 o'clock, 27.1% between 18 and 22 o'clock, and 20.6% between 22 and 2 o'clock. These differences showed statistical significance (P<0.05).
CONCLUSIONS
Variceal bleeding presenting with hematemesis occurred frequently from 18 to 2 o'clock and thus, showed significant diurnal variation.