Acute variceal hemorrhage: evaluation and comparison of treatment and long-term outcomes

Author: Mantė Valinskytė Title: Acute variceal hemorrhage: evaluation and comparison of treatment and long-term outcomes. Purpose: To evaluate and compare the long-term outcomes of patients with different treatment and prophylaxis methods of acute variceal hemorrhages. Tasks: 1. To compare long-term outcomes of different treatment methods during the acute hemorrhaging phase. 2. To compare long-term outcomes of different prophylaxis methods. 3. To evaluate factors that can cause death due to liver disease or induce the long-term rebleeding. Methods. A retrospective study of 147 patients - 147 cases of acute variceal bleeding admitted to LUHS Clinics during the period 2003-2014 was performed. The data about demographic, epidemiological and clinical chracteristics, information about the treatment and prophylaxis were collected from personal case histories and e-system and analysed using the software program SPSS 20.0. A P value of less than 0.05 was considered to be statistically significant. Results. The average age of patients was 54,67±14,00 years. The male and female ratio was 1,67:1 (p18 points (p=0,033). During the 11 year period 9,5% (14/147) of the patients died due to liver disease. The fact of death correlated with age of the patients (p=0,04), presence of ascites (p=0,046). Conclusions: Both endoscopic and medication treatments are effective not only for acute bleeding hemostasis, but also in a long-term approach. Endoscopic ligation procedure reduces the risk of rebleeding twice in comparison with other measures of treatment. Risk factors for rebleeding are: age above 55 years, varices localized in esophagus, Child-Turcote-Pugh class C, MELD score > 18 points. Presence of ascites hightens the risk of death from liver disease or it‘s complications 4 times