A Study on Natural History of Variceal Bleed in an Era of Sclerotherapy.

INTRODUCTION : Portal hypertension manifesting as gastrointestinal bleed is common in 30% of cirrhotic patients, with a one year mortality of 50% after the initial bleed. The greatest risk is during the first 48 to 72 hours and more than 50% of all early rebleed episodes occur within the first 10 days after cessation of active hemorrhage. While most of the reports on the variceal bleed pattern are from the West, little information is available from the Southern states of the Indian subcontinent. A preliminary observation from our center in 2003 had shown a low rebleed rate after the index bleed. This study had a drawback of inclusion of bleeders who were already on treatment and there was probably a bias towards a low rebleed rate. The present study was undertaken to prospectively assess the variceal bleed pattern and its attendant complications amongst cirrhotics with portal hypertension. Ethics committee of Institution approved the undertaking of the study. AIMS AND OBJECTIVES : 1. To determine variceal pattern amongst south Indian patients with cirrhosis Liver. 2. To study the prevalence of recurrent bleed. 3. To study the risk factors that predicts an index bleed and subsequent bleed. CONCLUSION : Esophageal variceal bleed pattern in 205 cirrhotics were studied between January 2005 to June 2006. Age and gender did not influence the bleed pattern amongst bleeders and non bleeders. Though unknown etiology among bleeders and viral related etiology among non bleeders were common causes for cirrhosis, it was not significant. Higher grades of varices, presence of cherry red spots and fundal varices were the predictors of variceal bleed in liver cirrhosis. The risk factors that influenced the subsequent bleeds were similar to that of the initial bleed. There was no role for co-morbid diseases such as diabetes and hypertension in variceal bleed and bleed related mortality. Most of index bleeders belonged to Childs A and became Childs B following bleed. Variceal bleed related mortality following endoscopic sclerotherapy was low