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The long-term morbidity and mortality rate in a cohort of patients with liver cirrhosis and oesophageal varices.
Hepatogastroenterology. 1995 Nov-Dec; 42(6):979-84.H

Abstract

BACKGROUND/AIMS

A long-term study and follow-up of an uniform treatment strategy for esophageal varices was evaluated to plan future strategies more effectively.

MATERIAL AND METHODS

Morbidity and mortality in 101 patients with liver cirrhosis followed up for 5 years in a single center after the first detection of oesophageal varices were studied.

RESULTS

Definitive hemostasis of the first variceal bleeding episode could not be obtained in 31.5%, despite emergency endoscopic sclerotherapy in combination with vasopressin and/or balloon tamponade. Mortality related to this bleeding was 26% in this cohort of patients. Overall mortality from variceal bleeding during the 5 year period was 38%. Death occurred predominantly in patients with advanced liver disease, since the Child-Pugh score of patients who bled and survived was 8 +/- 2 as compared to 11 +/- 2 (p<0.01) in those who bled and died. If fundic varices were the origin of the hemorrhage, the mortality reached 78% within 6 months. Eighty-five percent of the fatalities were related to the liver disease. Besides variceal bleeding, infection was the predominant trigger leading to liver failure; occurring in 25%. The cause of non-liver related death was malignancy of esophagus, lung and pancreas. Only 13% of the patients with liver failure had undergone an orthotopic liver transplantation.

CONCLUSION

Since variceal hemorrhage still carries a high mortality rate, primary prophylaxis for patients at high risk is indicated. The systematic, concomitant use of vasoactive drugs to sclerotherapy and the early performance of TIPS in case of failure of sclerotherapy have to be evaluated. Finally patients with an advanced liver disease and increased risk factors for variceal bleeding should be considered earlier for liver transplantation.

Authors+Show Affiliations

Department of Hepatogastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8847055

Citation

Nevens, F, et al. "The Long-term Morbidity and Mortality Rate in a Cohort of Patients With Liver Cirrhosis and Oesophageal Varices." Hepato-gastroenterology, vol. 42, no. 6, 1995, pp. 979-84.
Nevens F, Broeckaert L, Rutgeerts P, et al. The long-term morbidity and mortality rate in a cohort of patients with liver cirrhosis and oesophageal varices. Hepatogastroenterology. 1995;42(6):979-84.
Nevens, F., Broeckaert, L., Rutgeerts, P., Van Steenbergen, W., & Fevery, J. (1995). The long-term morbidity and mortality rate in a cohort of patients with liver cirrhosis and oesophageal varices. Hepato-gastroenterology, 42(6), 979-84.
Nevens F, et al. The Long-term Morbidity and Mortality Rate in a Cohort of Patients With Liver Cirrhosis and Oesophageal Varices. Hepatogastroenterology. 1995 Nov-Dec;42(6):979-84. PubMed PMID: 8847055.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The long-term morbidity and mortality rate in a cohort of patients with liver cirrhosis and oesophageal varices. AU - Nevens,F, AU - Broeckaert,L, AU - Rutgeerts,P, AU - Van Steenbergen,W, AU - Fevery,J, PY - 1995/11/1/pubmed PY - 1995/11/1/medline PY - 1995/11/1/entrez SP - 979 EP - 84 JF - Hepato-gastroenterology JO - Hepatogastroenterology VL - 42 IS - 6 N2 - BACKGROUND/AIMS: A long-term study and follow-up of an uniform treatment strategy for esophageal varices was evaluated to plan future strategies more effectively. MATERIAL AND METHODS: Morbidity and mortality in 101 patients with liver cirrhosis followed up for 5 years in a single center after the first detection of oesophageal varices were studied. RESULTS: Definitive hemostasis of the first variceal bleeding episode could not be obtained in 31.5%, despite emergency endoscopic sclerotherapy in combination with vasopressin and/or balloon tamponade. Mortality related to this bleeding was 26% in this cohort of patients. Overall mortality from variceal bleeding during the 5 year period was 38%. Death occurred predominantly in patients with advanced liver disease, since the Child-Pugh score of patients who bled and survived was 8 +/- 2 as compared to 11 +/- 2 (p<0.01) in those who bled and died. If fundic varices were the origin of the hemorrhage, the mortality reached 78% within 6 months. Eighty-five percent of the fatalities were related to the liver disease. Besides variceal bleeding, infection was the predominant trigger leading to liver failure; occurring in 25%. The cause of non-liver related death was malignancy of esophagus, lung and pancreas. Only 13% of the patients with liver failure had undergone an orthotopic liver transplantation. CONCLUSION: Since variceal hemorrhage still carries a high mortality rate, primary prophylaxis for patients at high risk is indicated. The systematic, concomitant use of vasoactive drugs to sclerotherapy and the early performance of TIPS in case of failure of sclerotherapy have to be evaluated. Finally patients with an advanced liver disease and increased risk factors for variceal bleeding should be considered earlier for liver transplantation. SN - 0172-6390 UR - https://www.unboundmedicine.com/medline/citation/8847055/The_long_term_morbidity_and_mortality_rate_in_a_cohort_of_patients_with_liver_cirrhosis_and_oesophageal_varices_ L2 - https://medlineplus.gov/cirrhosis.html DB - PRIME DP - Unbound Medicine ER -