The recent reduction in mortality from bleeding oesophageal varices is primarily observed from Days 1 to 5

Abstract

Background: Several new treatments of bleeding oesophageal varices (BOV) have been introduced during the last 25 years; among these are vasoactive drugs, improved endoscopic techniques and prophylactic antibiotics.

Aims: The aim was to compare clinical outcomes based on Baveno IV criteria in two patient-cohorts (1983-1987, n=56 and 2000-2007, n=111) with respect to control of bleeding, rebleeding and mortality after a first episode of BOV. Further, we wanted to assess whether an eventual reduction in bleeding-related mortality occurred within the first 5 days or between Days 6 and 42 after the bleeding episode.

Methods: Data from medical records were collected, according to the Baveno IV criteria, on key events: type of treatment, failure to control bleeding, failure to prevent rebleeding, 5-day and 6-week mortality.

Results: Six-week mortality decreased from 30.4 to 17.1% [odds ratio (OR) 0.44; 0.21-0.95] with a reduction in 5-day mortality from 17.9 to 6.3% (OR 0.31; 0.11-0.86). A non-significant reduction was seen in the 5-day failure rate to control bleeding from 35.7 to 26.1%. Mortality and failure to prevent rebleeding Days 6-42 decreased from 15.2 to 11.5% (NS) and 22.2 to 10.7% (NS) respectively. Mean length of hospital stay decreased from 14.6 +/- 12.5 to 9.1 +/- 9.0 days (P<0.01) and mean number of cumulated blood transfusions within the first 5 days decreased from 5.0 +/- 4.8 to 3.6 +/- 3.9 (P=0.05).

Conclusions: In this retrospective study on individual patient records, we observed a decrease in mortality from BOV over the last 20 years, which seems mainly owing to a reduction in 5-day mortality; mortality at Days 6-42 remained unaffected.