Improving prognosis following a first variceal haemorrhage over four decades

Abstract

Background: Variceal bleeding is a frequent cause of death in patients with cirrhosis and portal hypertension. Over the past 40 years a number of new techniques have been introduced to control active variceal haemorrhage. Many randomised controlled trials were performed to evaluate these new therapies. While most have demonstrated efficacy in controlling haemorrhage few showed improved survival.

Aim: The aim of this study was to investigate whether the prognosis for cirrhotic patients following a first variceal haemorrhage has improved over the past four decades.

Patients and methods: A total of 1475 patients included in the control or untreated arms of randomised controlled prophylactic trials for the primary prevention of variceal haemorrhage between 1960 and 2000. Twenty eight eligible randomised controlled studies were included. Over the 40 year period of observation there was a reduction in bleeding related mortality over time from approximately 65% to approximately 40% (p=0.024).

Conclusion: This study suggests that there has been a significant reduction in bleeding related mortality in patients with cirrhosis and portal hypertension over the past 40 years.

Figure 1

Percentage mortality for patients who bled in the control arms of prophylactic trials over the 40 years, 1960-2000. Bleeding related mortality declined significantly over time, p=0.026. The slope of the regression line is −0.85 ± 0.36 with r=−0.42.