VARICEAL BLEEDING IN CIRRHOTIC PATIENTS: RISK FACTORS, EVOLUTION, TREATMENT.

Objectives. The aim of this study was to monitor the risk factors that trigger variceal bleeding in cirrhotic patients, assess the severity of the bleeding and the efficacy of the endoscopic hemostasis techniques, as well as the recurrence of bleeding episodes and the mortality rate. Materials and Methods. The current study was a prospective one, and it was conducted in the period November 2004 - December 2006 in the "O. Fodor" Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca. It included 273 patients with upper gastrointestinal bleeding because of variceal rupture, assessed by emergency endoscopy. The patients included in the study met the clinical, biochemical, endoscopic and ultrasound criteriafor liver cirrhosis. Its etiology and staging were documentedfrom the patients 'observation charts. Results. Out ofthe 273 cases ofvariceal bleeding there were 255 (93.4%) cases of bleedingfrom esophageal varices and 18 (6.6%) from gastric varices. Variceal bleeding episodes were more frequent in patients with alcoholic liver cirrhosis (51.28%). Most patients with variceal bleeding were in Child class B or C (77%). Mortality because of variceal hemorrhage was 2.93% in the study group. A number of 148 patients were treated by scierotherapy and 125 patients with elastic ligatures. Bleeding relapses occurred in 65 (23.8%) patients within the study group, 43 men and 22 women. Variceal bleeding relapses were more frequent after scierotherapy than after elastic ligatures. Conclusions. Variceal bleeding occurred more frequently in patients with alcoholic cirrhosis stage Child C. In the current study mortality was relatively low The treatment of bleeding recurrence is more d~fficult, hence variceal rupture prevention and application of elastic ligatures represent a therapeutic necessity. [ABSTRACT FROM AUTHOR]