Life Science Journal 2013;10(4) http://www.lifesciencesite.com http://www.lifesciencesite.com @gmail.com lifesciencej 380 Potential Precipitating Factors of Variceal Bleeding Gamal F. El Naggar, Mahmod F. Selim, Atef M. Taha, Nashwa M. Nor Eldin, Loai M. Elahwal, Khalid Z. Darwish, Ahmed A. Abo omar Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt Abstract: Background and study aim: Variceal bleeding accounts for 10-30% of upper gastrointestinal haemorrhage and is a major cause of death in patients with cirrhosis. The incidence of chronic liver disease and hence portal hypertension in Egypt is exceptionally high, maintaining the highest prevalence of hepatitis C virus (HCV) worldwide, bilharzial periportal fibrosis as well as rising rates of hepatocellular carcinoma (HCC). In this work, we prospectively studied the potential precipitating factors for variceal bleeding in Middle Delta, Egypt. Patients and methods: Four hundred consecutive patients with liver cirrhosis who presented to Tanta University Hospital, from April 2011 till October 2011 with endoscopy documented acute variceal bleeding were invited to participate in the study. Our patients were classified into: Group I: 400 Patients with liver cirrhosis and acute variceal bleeding. Group II: 50 Matched patients with same Child-Pugh class and esophageal varices without bleeding (As a control group). All patients included in the study will be subjected to full history taking with a standard questionnaire regarding constipation, vomiting, cough, and other potential risk factors. Result: Vomiting, constipation and sever cough showed significant statistical increase in bleeding patients than the control group. (P.value < 0.05). The relation between the constipation and vomiting and the recurrence of bleeding was statistically significant. (P value < 0.05). Conclusion: Straining activities and infection could precipitate variceal bleeding episode. Routine vaccination, proper management of infection will reduce bleeding and rebleeding episode in cirrhotic patients with varices. [Gamal F. El Naggar, Mahmod F. Selim, Atef M. Taha, Nashwa M. Nor Eldin, Loai M. Elahwal, Khalid Z. Darwish, and Ahmed A.Abo omar. Potential Precipitating Factors of Variceal bleeding. Life Sci J 2013; 9(4):380-385]. (ISSN: 1097-8135). http://www.lifesciencesite.com . 50 Key words: Precipitating factors, variceal bleeding, Cough, constipation, infection 1.Introduction Upper gastrointestinal bleeding (UGIB): remains a significant source of mortality for both emergency admissions (11%) and inpatients (33%) (1) . Variceal bleeding accounts for 10-30% of upper gastrointestinal haemorrhage and is a major cause of death in patients with cirrhosis (2). At the time of diagnosis of cirrhosis, esophageal varices are present in about 60% of decompensated and 30% of compensated patients (3). The incidence of chronic liver disease and hence portal hypertension in Egypt is exceptionally high, maintaining the highest prevalence of hepatitis C virus (HCV) worldwide, bilharzial periportal fibrosis as well as rising rates of hepatocellular carcinoma (HCC) (4). Two theories have been proposed to explain variceal bleeding.The erosion hypothesis proposed that variceal hemorrhage resulted from an external trauma eroding the thin and fragile wall of the varices. Esophagitis and subsequent ulceration were the most commonly suggested erosives (5). At present, most authors accept the explosion hypothesis that suggests that the main factor leading to rupture of the varices is the increased hydrostatic pressure inside the varix and its ensuing consequences, increasing variceal size and decreasing the thickness of its wall (6). Several studies had discussed risk factors for variceal bleeding including clinical, endoscopic and hemodynamic parameters. The Northern Italian Endoscopic Club (NIEC) showed that there was a strong correlation between a patient's Child class at the time of endoscopy and the rate of bleeding during follow up (7). In this work, we prospectively studied the potential precipitating factors for variceal bleeding in Middle Delta, Egypt. 2. Patients and Methods Four hundred consecutive patients with liver cirrhosis who presented to Tanta university hospital, from April 2011 till October 2011 with endoscopy documented acute variceal bleeding were invited to participate in the study. Our patients were classified into: Group I: 400 Patients with liver cirrhosis and acute variceal bleeding. Group II: 50 Matched patients with same Child-Pugh class and esophageal varices without bleeding (As a control group) An informed consent was taken from all participants after explanation the study design and all procedures were approved by Faculty of Medicine Research Ethics Committee (REC). Exclusion criteria: