Risk factors for Variceal Bleeding

Abstract

Variceal bleeding is the most serious complication of portal hypertension.  It is seen in 50-60% of patients with cirrhosis.  The mortality in patients wo develop gastroesophageal variceal bleeding is approximately one third.  In patients who have never bled from esophageal varices, 30% will hemorrhage within one year after the diagnosis of varices.  The risk of bleeding after the initial bleed has been reported in the literature to be between 50 and 80%.  In addition, approximately one-half of all rebleeds occur within the first six weeks.  Beyond the sixth week after the initial bleeding episode, the risk of further bleeding returns to the same level of risk as in patients who have never bled (i.e., 30% within one year).  With these figures in mind, it is important to be aware of the risk factors for gastroesophageal variceal hemorrhage.  This paper examines the risk factors that may help identify patients most likely to bleed or rebleed.  Specifically, risk factors for:  1) initial bleeding 2) early rebleeding (bleeding within six weeks of the initial bleed) and 3) late rebleeding (greater than six weeks from the initial bleed) are discussed.