Recurrent upper GI bleeding - Forum

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Surrgeon

Recurrent upper GI bleeding - Ärzteforum

Post#1 »

Elderly nice retired schoolteacher with lupus, autoimmune hepatitis, spenomegaly, tiny probably never bleeding esophageal varices and recurrent upper GI bleeding with following findings each time:
Mild distal esophageal stricture (not clinically significant and not dilated because didn't want to cause more bleeding)
Distal esophagitis just below stricture, not bleeding
Tiny patches of Barrett's esophagus above this
Tiny hiatal hernia
Linear branching shallow ulcers of mid and upper stomach
H pylori negative

Bled in December and again this week, black stools for a few days, lightheaded, weak, hemoglobin down to about 9.5, feels better after 1 Unit packed cells.

Had been on prednisone over 1 year ago but taken off by gastroenterologist because of worries about GI bleeding Has been on omeprazole 20 mg daily.

I had wondered in Dec whether something could be done about her autoimmune hepatitis which I suspect is the ultimate reason for her bleeding. She went off to her gastroenterologist for his opinion, but came back just continuing on the omeprazole.

She does not take any other causative meds. Only other med is propranolol for hypertension.

Is there anything that could be added to prevent future bleeding or to control her autoimmune hepatitis?


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A Doctor

Re: Recurrent upper GI bleeding - Ärzteforum

Post#2 »

Autoimmune hepatitis is a lethal disease. It should be treated. First line -- steroids. Second line -- Imuran or 6MP. Otherwise, should have the "usual" regimen for liver dz (no EtOH, beta-blockers, etc.)

They bleed from the usual causes in advanced liver disease (varricies, PUD, etc.) I would keep her on enough steroids or immunosuppressives to bring LFT's to normal or near normal. If she is a liver transplant candidate, and has progressed far enough to need it within the waiting time in your area (2 yrs in Maryland), consultation with a OLTx center is appropriate.

Does she have a portal - htn gastropathy?

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