Retrospective Study
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World J Gastroenterol. Aug 28, 2014; 20(32): 11326-11332
Published online Aug 28, 2014. doi: 10.3748/wjg.v20.i32.11326
Hospitalization for variceal hemorrhage in an era with more prevalent cirrhosis
Nicholas Lim, Michael J Desarno, Steven D Lidofsky, Eric Ganguly
Nicholas Lim, Steven D Lidofsky, Eric Ganguly, Division of Gastroenterology and Hepatology, University of Vermont College of Medicine, Burlington, VT 05401, United States
Michael J Desarno, Department of Biostatistics, University of Vermont College of Medicine, Burlington, VT 05401, United States
Author contributions: Lim N contributed to the study design, acquisition of data, analysis and interpretation of data, drafting of manuscript; Lidofsky SD contributed to the study design, analysis and interpretation of data, critical revision of manuscript; Desarno MJ contributed to statistical analysis, drafting of manuscript; Ganguly E contributed to the study concept and design, acquisition of data, analysis and interpretation of data, drafting and revision of manuscript.
Correspondence to: Eric Ganguly, MD, Assistant Professor, Division of Gastroenterology and Hepatology, University of Vermont College of Medicine, Smith 235A, Fletcher Allen Health Care, 111 Colchester Avenue, Burlington, VT 05401, United States. eric.ganguly@vtmednet.org
Telephone: +1-802-8476618 Fax: +1-802-8474928
Received: January 17, 2014
Revised: March 11, 2014
Accepted: May 23, 2014
Published online: August 28, 2014
Abstract

AIM: To examine hospitalization rates for variceal hemorrhage and relation to cause of cirrhosis during an era of increased cirrhosis prevalence.

METHODS: We performed a retrospective review of patients with cirrhosis and gastroesophageal variceal hemorrhage who were admitted to a tertiary care referral center from 1998 to 2009. Subjects were classified according to the etiology of their liver disease: alcoholic cirrhosis and non-alcoholic cirrhosis. Rates of hospitalization for variceal bleeding were determined. Data were also collected on total hospital admissions per year and cirrhosis-related admissions per year over the same time period. These data were then compared and analyzed for trends in admission rates.

RESULTS: Hospitalizations for cirrhosis significantly increased from 611 per 100000 admissions in 1998-2001 to 1232 per 100000 admissions in 2006-9 (P value for trend < 0.0001). This increase was seen in admissions for both alcoholic and non-alcoholic cirrhosis (P values for trend < 0.001 and < 0.0001 respectively). During the same time period, there were 243 admissions for gastroesophageal variceal bleeding (68% male, mean age 54.3 years, 62% alcoholic cirrhosis). Hospitalizations for gastroesophageal variceal bleeding significantly decreased from 96.6 per 100000 admissions for the time period 1998-2001 to 70.6 per 100000 admissions for the time period 2006-2009 (P value for trend = 0.01). There were significant reductions in variceal hemorrhage from non-alcoholic cirrhosis (41.6 per 100000 admissions in 1998-2001 to 19.7 per 100000 admissions in 2006-2009, P value for trend = 0.007).

CONCLUSION: Hospitalizations for variceal hemorrhage have decreased, most notably in patients with non-alcoholic cirrhosis, and this may reflect broader use of strategies to prevent bleeding.

Keywords: Varices, Gastrointestinal bleeding, Cirrhosis, Hospitalization, Portal hypertension

Core tip: Strategies to prevent gastroesophageal variceal bleeding, a morbid complication of cirrhosis, have been largely unchanged for 15 years. With the rising burden of cirrhosis over this time, it might be predicted that there would be a parallel increase in hospitalization rates for this complication. The findings from this study show that hospitalization rates for variceal bleeding are in fact decreasing, specifically in non-alcoholic cirrhosis. This raises the possibility that reductions in hospital admissions for variceal bleeding are attributable to more widespread use of prophylactic measures, and that expansion of these measures in patients with alcoholic cirrhosis could further reduce hospitalizations.