Abstract

Research Article

Bleeding from Varices: Still a Heavy Burden in Patients with Cirrhosis

Amitrano L*, Guardascione MA, Saviano S, Martino A and Lombardi G

Published: 27 December, 2023 | Volume 7 - Issue 1 | Pages: 035-037

Introduction: Bleeding from varices is a severe complication in patients with cirrhosis. Despite its treatment has been well established in the last three decades the mortality can be still high. This study compares the epidemiological features and the bleeding-related outcomes of a group of patients published about ten years ago with a more recent group of 168 consecutive patients. 
Methods: The diagnosis, the treatment, and the main outcomes (5-day failure, 5-day and 6-week rebleeding, 5-day and 6-week mortality) of variceal bleeding were evaluated according to the current guidelines.
Results: The number of patients with cirrhosis admitted for variceal bleeding every year has progressively decreased in the last ten years. The age sex and severity of liver disease, evaluated with Child Pugh and MELD scores, were comparable in the two series. In the more recent series, there were significantly fewer patients with HCV infection and more patients with alcohol-related cirrhosis. The main outcomes of bleeding were comparable too. Overall, at 6 weeks 36.4% of patients did not overcome the bleeding episode. 
Conclusion: The decreasing incidence of bleeding from varices is likely attributable to antiviral treatment of HCV and HBV and the larger diffusion of beta-blockers in primary prophylaxis. Despite the larger application of the gold standard therapy, the mortality of variceal bleeding remains high in patients with cirrhosis.

Read Full Article HTML DOI: 10.29328/journal.acgh.1001043 Cite this Article Read Full Article PDF

Keywords:

Varices; Bleeding; Cirrhosis

References

  1. de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-974. doi: 10.1016/j.jhep.2021.12.022. Epub 2021 Dec 30. Erratum in: J Hepatol. 2022 Apr 14;: PMID: 35120736.
  2. Amitrano L, Guardascione MA, Manguso F, Bennato R, Bove A, DeNucci C, Lombardi G, Martino R, Menchise A, Orsini L, Picascia S, Riccio E. The effectiveness of current acute variceal bleed treatments in unselected cirrhotic patients: refining short-term prognosis and risk factors. Am J Gastroenterol. 2012 Dec;107(12):1872-8. doi: 10.1038/ajg.2012.313. Epub 2012 Sep 25. PMID: 23007003.
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  4. de Franchis R . Evolving consensus in portal hypertension. Report of the Baveno IV Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol 2005; 43 : 167 – 76.
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