esophagael variceal bleeding

[Noni12]

My husband was taken to the local hospital as an emergency when he passed blood in his stools and also when he vomited (only 1 time).  They found esophagael variceal bleeding when they did an endoscopy and banded quite a few bleeds.  We are moving to NC next week and do not have a Doctor.  First,  how serious is this bleeding?  Second,
how do you know if it occurs again (other than passing blood).Thirdly, they told my husband he most likely has a cirrhotic liver.  Do these bleeds happen with any other condition?  Finally, how fast should he see a hepatologist?
I am already in our new home and he was joining me next week so I do not have the opportunity to ask any of the Doctor's these questions.  Thank you

[Noni12]

Thank you for your response.  I have been surprised at the responses to my posting.  It is overwhelming to realize so many people take the time out of their busy days to respond.  It helps.  God bless you and your husband.

Noni12

[mikesimon]

Until recently it was believed that cirrhosis could not improve. Lately there are studies which suggest that in hepatitis c patients who achieve SVR their liver histology can improve and cirrhosis can regress. I have pasted an excerpt form a recent study and provided the link to the article.

"Cirrhosis Regression During HCV Therapy Associated With Improved Liver-Related Morbidity, Mortality During Long-term Follow-up

Posting Date: April 25, 2008

    * Longitudinal nonrandomized trial

Summary of Key Conclusions

    * Cirrhosis regression occurs in patients chronically infected with HCV following antiviral therapy and impacts clinical outcome
          o No liver-related events including cancer, transplantation, or death in patients with regression of cirrhosis even if veremia persists
    * Should consider cirrhosis regression a primary endpoint in patients with cirrhosis

Main Findings

    * During 10-year follow-up, incidence of liver-related events, including cancer, evident among patients with sustained virologic response (SVR), but lower than those who did not achieve SVR (P = .002)
          o 3 deaths or transplantations due to hepatocellular carcinoma
    * No evidence of liver-related events among patients with cirrhosis regression, but prominent among patients without cirrhosis regression (P = .01)
          o No liver-related deaths or liver transplantations among patients with cirrhosis regression (P = .025 vs patients without regression)
    * Virologic response reached in one third of patients
          o SVR: n = 35 (36.4%)
          o No SVR: n = 61 (63.6%)
    * Cirrhosis regression occurred in 19% of patients
          o Yes: n = 18 (19%)      
                + Follow-up: 115 ± 42 months
          o No: n = 78 (81%)
                + Follow-up: 112 ± 35 months
          o Median duration between pretreatment and posttreatment liver biopsy: 38 months (range: 23-69 months)
    * Normal prothrombin time and SVR independently associated with cirrhosis regression
          o Prothrombin time 92.6% of normal in patients with cirrhosis regression vs 83.2% for those without cirrhosis regression
                + Odds ratio: 1.1 (95% confidence interval: 1.02-1.10)
          o SVR 94% among those with cirrhosis regression vs 23% for those without cirrhosis regression
                + Odds ratio: 69.1 (95% confidence interval: 7.8-612.3)  

Reference

Mallet V, Gilgenkrantz H, Serpaggi J, et al. Regression of hepatitis C-related cirrhosis and long-term survival. Program and abstracts of the 43rd Annual Meeting of the European Association for the Study of the Liver; April 23-27, 2008; Milan, Italy. Abstract 12."

See Clinical Care Options site at:   http://tiny.cc/enkPd
You must be registered to view but it's free and easy to register.

Mike

[Grace724]

I'd encourage you to call your current doctors office and ask for a referral to a doctor in your new location. Then I'd get him an appt. asap. Explain what is going on and they should be in agreement that he needs to be seen soon.

My understanding that bleeding from these varices can occur very suddenly and that it is possible to lose enormous amounts of blood very quickly. Making a bleed a near fatal situation. I'd not waste any time getting him in to a doctor to get some guidance on how to handle this and to learn what to look for, etc.

The fact that your husband does not drink is a great plus. However, if as the doctor suspects he has cirrhosis that's not good news. Once a liver becomes cirrhotic you can't reverse that. Cirrhosis of the liver means the liver tissue has become hard and that situation can't be changed. That's the last stage of liver disease. Your husband needs a liver biopsy as soon as possible to accurately determine what stage and what grade his liver is at. You can google liver disease, grade, stage and get a lot of good information.

You mentioned him seeing a heptologist...does this mean he has Hepatitis C? My husband does and never treated for it and unfortunately he drank. He quit drinking in February after he became near comatose from a build up of ammonia in his system. He is now on Lactulose daily to control the amount of ammonia in his body and on a low protein diet. His liver disease has progressed to the point that his liver can no longer break protein down into ammonia and then further down into urea to be removed by the kidneys. So he has to take the lactulose in order for the ammonia to bind itself to the medication and be removed via bowel movements. Not a pleasant way to live your daily life, but necessary for him. So far my husband has not experienced any varices. He has had a liver biopsy and he was found to be at stage 4 (last stage and means he has cirrhosis) and at grade 1 which is the best grade because it means his liver is not inflamed at the present time. That grade could change very quickly and then his only hope is for a liver transplant.

I'd definitely get him into see a doctor as quickly as possible and I'd request a liver biopsy so you can determine where his liver is in the grades and stages. then I'd educate myself as much as possible to learn all you can about his disease. Unfortunately as time progresses you'll become his caretaker and you need to be as knowledgeable as possible.  It's very important for your husband as well to understand all he can about what is happening to him. If he would begin to suffer the hepatic encephalopathy that my husband has issues with now he needs to know how that can and will impact his life. His ability to work, etc. I wish we had known more about what was coming down the road for us and could've planned accordingly. Now we're trying desperately to get our ducks in a row for the eventuality that he will become unable to work. He's 51 and our sole breadwinner. It's a quite a shock when you thought you had at least 15 more years to pad your retirement fund and find out that the time is probably considerably shorter.

All I can say is good luck to you both, get yourselves a doctor that you like, feel comfortable with and one who will be honest and open with you about what's going on. One you can ask questions of and feel confident that you're being heard and answered completely. Then as I said, read. Read everything you can to understand and prepare yourselves for the future. Also learn what you and he need to be doing to get him into his best fighting shape for the battle down the road. Get yourselves on the defensive so you can be prepared to fight back.

Best of luck to you.

~Grace

[boninclyde]

Dr. Laminetti spelling at Carolinas Medical Center (an amazing doctor) I will try to send news article about him to you and there is another good one in Mooresville. Bluminthal Cancer Center. I will post first thing in the morning with phone numbers. Welcome to North Carolina!

[boninclyde]

I did not see in your post anywhere that your husband has hep. Does he or has he been tested? Please don't wait anytime there is bleeding they need to move quickly with blood work and scans to see what the problem is. I am not a doctor just someone that has been through to much. I am from North Carolina. Charlotte, Huntersville, Mooresville area. If I can help with a doctor recommendation let me know.

[REVRAT]

Try to get him asap to Doctor. The blood can start seeping from other veins in the throat or stomach. I have had the same problems on band litigation before. This can be from ulcers or liver.Try to keep him relaxed without heavy exertion for now and watch the sodium intake very close. Try to get him to drink as much water as possible.The fact that he doesn't drink is great. If this is liver then it is very important to start treatment to slow down effects.It is possible to reverse the damage if caught in time.They will likely want to do another upper GI in near future to recheck for leakage then  once a year checkup.As the blood settles in stomach it collects in the bottom. You may not see evidence of it for a length of time before it happens again.I wouldn't put off this very long due to the move but understand moving is bad enough.Don't want to scare you but hep is not to play around without help. Ask if someone in your area is on this Forum for doctors that they recomend for referral. Best wishes to you    REVRAT  

[Noni12]

I failed to mention that he does not drink so it is not alcohol related.