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CZECH MEDICAL ASSOCIATION J. Ev. PURKYNĚ |
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Česky / Czech version | Vnitř. Lék., 48, 2002, No. 10, p. 989 - 992 |
Influence of Bacterial Infection on the Development
and Course of Acute Haemorrhage from Oesophageal Varices Husová L.1, Lata J.1, Šenkyřík M.1, Husa P.2 1Interní gastroenterologická klinika FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Petr Dítě, DrSc. 2Klinika infekčních chorob FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Pavel Chalupa, CSc. |
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Summary: Acute haemorrhage from the upper portion of the gastrointestinal tract is a frequent complication
which develops in ca 35-66 % of patients with cirrhosis of the liver and portal hypertension. It
is assumed that one of the trigger mechanisms of varicose haemorrhage can be bacterial infection.
However accurate data on the influence of infection on the development and course of haemorrhage
are still lacking. The mortality of patients bleeding from oesophageal varices is very high
(30 - 70 %). Usually the cause of death is not haemorrhagic shock but haemorrhage-induced
changes which lead to hepatic failure. It is assumed that in this very process an important part is
played by bacterial infection with subsequent release of endotoxins. Most recent metaanalyses
indicate that bacterial infection is an independent prognostic factor as regards failure to arrest
haemorrhage and influences in a significant way the mortality of these patients. Antibiotic treatment
of patients with varicose haemorrhage increases the survival period of these patients.
Therefore to cirrhotic patients with varicose haemorrhage antibiotics should be administered
prophylactically, i.e. not only to patients with evidence of infection but also those without these
symptoms. The authors consider as the optimal antibiotic treatment administration of quinolones
orally or by the i.v. route, possibly cephalosporins which seem to be equally effective as quinolones.
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