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Objectives: This study focuses on the etiology of acute upper gastrointestinal (GIT) bleeding in liver cirrhosis patients., Methods: A prospective examination of 137 liver cirrhosis patients with acute upper GIT bleeding. All patients underwent endoscopic examination and in the case of multiple findings, definition of the source of bleeding was based on the endoscopic report., Results: The most frequent causes of acute bleeding were: oesophageal varices (57.7%), peptic gastric and duodenal ulcers (18.2%), portal hypertension gastropathy (9.5%), gastric varices (5.1%), reflux oesophagitis (2.9%), Mallory-Weiss syndrome (2.9%) and erosive gastropathy (1.5%). A negative diagnosis was made in not more than 2.2% of patients. The majority of cases showed multiple findings in the upper digestive tract, each of which was a potential cause of bleeding. The mortality in all bleeding cirrhotic patients was 14.6%, 18.6% of which occurred in the varicose type of bleeding and 7.8% in the non-varicose type., Conclusions: Portal hypertension led to bleeding caused by varices and portal hypertension gastropathy in 72.3% of patients, 62.8% of patients suffered from purely varicose bleeding and 37.2% from non-varicose bleeding. Early, detailed endoscopic examination leading to appropriate diagnosis and treatment is of paramount importance.

Introduction: Acute upper gastrointestinal bleeding still remains one of the serious conditions that require a rapid diagnostic and therapeutic intervention. Such procedure is highly dependent on good interdisciplinary cooperation, which, when centralized, may positively influence mortality and economic costs., Objective: To determine the benefits of centralization of care provided to patients with acute bleeding in the upper gastrointestinal tract., Patients and Methods: A total of 632 patients with acute bleeding were enrolled in the study at two different health-care establishments of the same type, however with a different organisation of care. We have evaluated the influence of the organisation of care on the length of hospitalization stay, mortality and economic costs., Results: Centralized treatment significantly shortens the interval from hospital admission to endoscopic examination and leads to a reduction in mortality, although not statistically significant. On the other hand, it does not affect the length of hospitalization, the distribution of patients between internal and surgical departments, and provides no guarantee of lower economic costs. Many other factors play an important role in that respect. It seems, that the importance of centralization plays the main role especially in the pre-hospital and early hospital period, when it accelerates and simplifies the diagnostic and therapeutic procedure.

Objectives: The study focuses predominantly on non-varicose sources of acute upper gastrointestinal bleeding in liver cirrhosis patients and aims to determine its mortality., Methods and Subjects: The prospective examination included 137 liver cirrhosis patients with acute upper GIT bleeding. All the patients underwent an endoscopic examination. In case of multiple findings, defining the bleeding source was based on the specialist's attitude presented as the conclusion of the endoscopic examination., Results: The most frequent causes of acute bleeding included oesophagus varices (57.7%), followed by peptic gastric and duodenal ulcers (18.2%), then portal hypertension gastropathy (9.5%), gastric varices (5.1%), reflux oesophagitis (2.9%), Mallory-Weiss syndrome (2.9%) and erosive gastropathy (1.5%). The endoscopy of the upper digestive tract resulted in a negative diagnosis in not more than 2.2% of patients. The majority of examinations showed multiple findings in the upper digestive tract, each of which could have been a potential cause of bleeding. Mortality in all bleeding cirrhotic patients reached 14.6%, 18.6% of which were related to the varicose type of bleeding and 7.8% to the non-varicose type., Conclusion: Portal hypertension led to bleeding (caused by varices and portal hypertension gastropathy) in 72.3% of patients, 62.8% patients suffered from purely varicose bleeding, 37.2% patients from non-varicose bleeding. Mortality was statistically significantly higher on 0.1 level of significance in cases of varicose bleeding in comparison with non-varicose bleeding. An emphasis should be laid on an early and detailed endoscopic examination leading to an appropriate diagnosis and therapy.

108 patients suffering from the cirrhosis of the liver and acute bleeding into the upper digestive tract underwent a prospective endoscopic examination with diagnostic and therapeutic objectives. The most frequent causes of acute bleeding included oesophagus varices (57.4%) followed by peptic gastric ulcer (13.9%) and peptic ulcer of duodenum (11.1%), then portal hypertension gastropathy (5.6%), gastric varices (4.6%), reflux oesophagitis (2.8%), Mallory-Weiss syndrom (2.8%) and erosive gastropathy (0.9%). The endoscopy of the upper digestive tract in one patient resulted in negative diagnosis. 69% of examinations showed multiple findings in the upper digestive tract, each of which could have been a potential cause of bleeding. To determine the source of bleeding the specialist's attitude presented at the end of the endoscopic examination was taken into consideration. In 67.6% of patients the bleeding was a direct consequence of portal hypertension, in 62% it was caused by varices. The emphasis is put on early and thorough endoscopic examinations aimed at proper diagnosis and therapy.

The authors present the results of a long-term monitoring of patients who presented with clinical signs of bleeding from the upper gastrointestinal tract (GIT) but totally negative endoscopy results on admission. Retrospective-prospective analysis of acute endoscopies in patients with clinical signs of bleeding from the upper gastrointestinal tract performed in the Endoscopy Centre of the OstravaTeaching Hospital from 2002 to 2005, long term monitoring of the sample with negative results on admission. A total of 133 patients, i.e. 16.3 % of all acute procedures, with no source of bleeding detected in the first endoscopy. 26.4% of wrong indications. In the rest of the sample, a source of bleeding was detected by endoscopy in 17 patients (15 in an early examination and 2 within one month from the event), i.e. 17.3%. The rate of bleeding recurrence was 15%. The risk of recurrence was higher in patients with haematemesis and a decrease in the blood count (BC) at the time of the first event. In 19 patients, i.e. 14.3%, the source was not detected. In the remaining 33 patients, the findings were as follows: 1) in 4 patients, the source of bleeding was detected in the small intestine (push enteroscopy or enteroclysis); 2) in 3 patients, the source of bleeding was detected in the colon; 3) in 6 patients, IBD was detected; 4) in 5 patients, cirrhosis of the liver was diagnosed within months or years from the event.