The Evaluation of Diabetes Mellitus as an Independent Risk Factor for Gastroesphageal Variceal Bleeding in Cirrhotic Patients

Abstract
Background: Diabetes mellitus has been reported to increase the risk of complications of liver cirrhosis and subsequent survival. Varices constitute the most common lethal cause of mortality in cirrhotic patients, consequently the association between DM and gastro-esophageal variceal bleeding becomes the focus of attention.
Aim of Study: Is to elucidate whether DM is an independent risk factor for gastro-esophageal variceal bleeding in cirrhotic patients.
Patients and Methods: This cross-sectional study was conducted in Internal Medicine Department, Faculty of Med-icine, Tanta University Emergency Hospital at Gastro-endoscopy Unit from September 2017 to July 2018 and included 120 patients. Group (A): Diabetic cirrhotic patients with upper gastrointestinal variceal bleeding. Group (B): Non-diabetic cirrhotic patients with upper gastrointestinal variceal bleeding. The patients were subjected to history taking, laboratory investigations including: CBC, AST, ALT, bilirubin, albumin, blood urea, serum creatinine, Pa, INR, HBVs Ag, anti HCV Ab, RBG, HbA1c and gastrointestinal endoscope.
Results: Of the 120 patients, there were 67 (55.8%) diabetics, 53 (44.2%) were non-diabetics, they were 47 (39.2%) child A, 73 (60.8%) child B & C. GEVB incidence was higher in child B & C than child A, also as regard sub grouping in child A, the diabetic patients were 32 (68.1%) while non-diabetics were 15 (31.9%) and in child B & C diabetics were 35 (47.9%) and non-diabetics were 38 (52.1%) with p-value (0.030), there was significant higher ratio of ascites, enceph-alopathy and recurrence of attacks of GEVB in child B & C than child A, there was significant higher ratio of ascites, previous attacks of encephalopathy and recurrence of attacks of GEVB in diabetics than non-diabetics and there was statis-tically significant higher incidence of recurrence of attacks of GEVB with HBA1c >7.
Conclusion: The incidence of GEVB was significantly associated with DM in cirrhotic patients, especially in patients with Child-Pugh Class A.