Gastrointestinal bleeding is a common and potentially life-threatening complication of liver cirrhosis, mainly resulting from portal hypertension. It represents a major cause of morbidity and mortality in this patient population. Early identification of risk factors is essential to prevent this complication and to guide an appropriate management strategy. Through this study, we aimed to describe the clinical, biological, and etiological characteristics of cirrhotic patients presenting with gastrointestinal bleeding, and to analyze the predictive factors associated with its occurrence.

This was a retrospective, descriptive, and analytical monocentric study conducted in the Hepato-Gastroenterology and Proctology Department “Medicine B” of Ibn Sina University Hospital in Rabat.The study included 122 patients with liver cirrhosis over a 6-year period, from July 2018 to November 2025. Predictive factors for gastrointestinal bleeding were assessed using binary logistic regression, performed with JAMOVI software. A p-value < 0.05 was considered statistically significant.

Among the 122 included patients, gastrointestinal bleeding occurred in 46 patients (37.7%).Regarding demographic characteristics, there were 24 men (52.1%) and 22 women (47.9%), with a mean age of 52.3 ± 14.9 years. Smoking was reported in 9 patients (19.5%), type 2 diabetes in 7 patients (15.2%), and alcohol consumption in 2 patients (4.3%).The ECOG performance status was 0 in 22 patients (47.8%), 1 in 13 patients (28.2%), 2 in 9 patients (19.5%), and 3 in 2 patients (4.3%).

According to the Child-Pugh classification, 12 patients (26%) were Child A, 13 (28.2%) Child B, and 21 (45%) Child C.

Platelet count was < 50,000/mm³ in 12 patients (26.1%), prothrombin time < 50% in 18 patients (39.1%), and the mean serum albumin level was 29.7 ± 8.6 g/L.

Cirrhosis etiologies included HBV in 14 patients, HCV in 12 patients, NASH in 4 patients, alcohol in 3 patients, PBC in 4 patients, AIH in 1 patient, Wilson’s disease in 1 patient, and cryptogenic cirrhosis in 4 patients. Three patients were still undergoing etiological assessment.

Upper endoscopy revealed grade III esophageal varices in 18 patients, grade II in 16 patients, and grade I in 11 patients.

Multivariate analysis identified the following as the main predictive factors for gastrointestinal bleeding:

Child-Pugh C score (OR = 2.73, CI = 1.04–7.13, p = 0.04)

Neurological decompensation (OR = 4.55, CI = 1.49–13.89, p = 0.008)

Portal vein thrombosis (OR = 0.2, CI = 0.06–0.65, p = 0.008)

This study highlights the principal predictive factors of gastrointestinal bleeding in cirrhotic patients, particularly a high Child-Pugh score, neurological decompensation, and portal vein thrombosis. These findings emphasize the need for close monitoring and optimised management of patients presenting with these risk factors to reduce morbidity and mortality. A preventive strategy combining control of portal hypertension and management of complications may improve outcomes in cirrhotic patients.