Declining hospitalization rate of esophageal variceal bleeding in the United States.

Division of Gastroenterology, Long Beach Veterans Affairs Medical Center, Long Beach, California 90822, USA.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association (Impact Factor: 6.53). 06/2008; 6(6):689-95; quiz 605. DOI: 10.1016/j.cgh.2008.02.049
Source: PubMed

ABSTRACT In recent years, there have been many advances in the primary and secondary prophylaxis of variceal bleeding. The aim of this study was to evaluate nationwide trends in the hospitalization rate of bleeding esophageal varices in the advent of these new modalities. In addition, our aims were to study the incidence trends of nonbleeding esophageal varices over the past 2 decades while studying hospitalization rates for cirrhosis over the same study period.
The Nationwide Inpatient Sample database was used for inpatient data analysis (1988-2002) and the State Ambulatory Surgery Database was used for outpatient analysis. Patients discharged with International Classification of Diseases, ninth revision, Clinical Modification discharge diagnoses related to esophageal varices were included.
The hospitalization rate of bleeding varices increased 13.7% from 10.9 per 100,000 in the 1988 to 1990 period to 12.4 per 100,000 in the 1994 to 1996 period (P < .01), and then decreased 14.5% to 10.6 per 100,000 in the 2000 to 2002 period (P < .01). In-hospital nonbleeding varices increased 55% from 6.0 to 9.3 per 100,000 from the 1988 to 1990 period to the 2000 to 2002 period (P < .01). Outpatient nonbleeding esophageal varices increased 20% from 5.5 to 6.6 per 100,000 from 1997 to 2003.
The hospitalization rate for bleeding esophageal varices has been on the decline in recent years and may be a reflection of the advances in primary and secondary prophylaxis. The incidence rate of nonbleeding esophageal varices is increasing and likely is owing to the increasing burden of portal hypertensive liver disease in the nation.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background / Aim: Balloon tamponade has been widely available in emergency situations of acute variceal bleeding. To lessen the complications of Balloon tamponade, a new special type of stent for exclusive use in acute variceal bleeding has been developed. This study aims to investigate the effectiveness and safety of the new self-expandable metal stents (SEMS) in the initial control of acute variceal bleeding. We also hypothesized that using SEMS can bridge the acute bleeding episode converting endoscopic management by sclerotherapy or band ligation to an elective procedure. Patients and Methods: Twenty patients with acute variceal bleeding were included in the study and 16 of them were allocated to receive stent treatment. Results: Stent deployment was successful in 15 of 16 patients (93.75%). Technical errors were reported in 3 (18.75%) patients. Initial control of variceal bleeding was reported in 14 (out of 16) (87.5%) patients. The mean duration of the procedure was 10 (±6) min. Mortality was reported in 4 (25.0%) patients. Conclusion: SEMS is a safe and effective mean to control acute variceal bleeding.
    Saudi Journal of Gastroenterology 03/2013; 19(4):177-181. DOI:10.4103/1319-3767.114516 · 1.22 Impact Factor
  • [Show abstract] [Hide abstract]
    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.
    World Journal of Gastroenterology 08/2014; 20(32):11326-32. DOI:10.3748/wjg.v20.i32.11326 · 2.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Acute variceal bleeding (AVB) is the most common cause of upper gastrointestinal hemorrhage in patients with cirrhosis. Advances in the management of AVB have resulted in decreased mortality. To minimize mortality, a multidisciplinary approach addressing airway safety, prompt judicious volume resuscitation, vasoactive and antimicrobial pharmacotherapy, and early endoscopy to obliterate varices is necessary. Placement of a transjugular intrahepatic portosystemic shunt (TIPS) has been used as rescue therapy for patients failing initial attempts at hemostasis. Patients who have a high likelihood of failing initial attempts at hemostasis may benefit from a more aggressive approach using TIPS earlier in their management.
    Clinics in liver disease 05/2014; 18(2):347-357. DOI:10.1016/j.cld.2014.01.001 · 2.70 Impact Factor