Variceal hemorrhage in patients with cirrhosis

nighthawk

SourceURL:http://www.gastrohep.com/news/news.asp?id=2273



Despite effective drugs and endoscopic therapy for variceal bleeding,
almost a quarter of deaths occur very soon after bleeding onset, find
physicians in the October issue of the Journal of Hepatology.

Studies have suggested that the prognosis of patients with cirrhosis and
variceal hemorrhage has improved more recently.

Physicians from France performed a prospective cohort study where the
choice of prophylactic therapy was left to each practitioner. The team
followed cirrhotic patients with medium and large varices in order to
determine which factors predict bleeding and death.

There were 314 patients with grades 2 or 3 esophageal varices enrolled in
the study. Of these, 173 had no previous history of variceal bleeding.

Not all patients were receiving some form of prophylactic therapy. While
100% of patients with prior variceal hemorrhage were receiving prophylactic
therapy, only 61% of patients without prior hemorrhage were.

Overall, the median follow-up was 18 months.

9 deaths occurred within 24 hours of bleeding onset.
Journal of Hepatology

The physicians found that there were 76 bleeding events and 14 related
deaths. They determined that 9 of the deaths occurred within 24 hours of
bleeding onset.

In addition, there were 25 deaths that were not due to bleeding, but were
related to cirrhosis.

Using a Cox model, the physicians identified that the presence of tense
ascites (relative risk 3.4), and a history of hemorrhage (relative risk
4.4) were independent predictors of variceal hemorrhage.

They also found that in patients with no history of bleeding, bleeding risk
was higher with prolonged prothrombin time, and lower when patients were
receiving propranolol.

Dr Delphine Nidegger's team concluded, "Despite the advent of effective
drugs and endoscopic therapy for variceal bleeding, about a quarter of
deaths occur very early after bleeding onset, confirming the need for rapid
specific management".

J Hepatology 2003; 39(4): 509-14
15 September 2003

"Enlightenment does not come 'by imagining figures of light but by making
the darkness conscious.'"  (Jung)