Declining hospitalization rate of esophageal variceal bleeding in the United States
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.
Article: Portal hypertension[Show abstract] [Hide abstract]
ABSTRACT: Portal hypertension is the most common complication of cirrhosis accounting for significant morbidity and mortality mainly because of variceal hemorrhage, ascites, bacterial infections, hepatic encephalopathy, and hepatorenal syndrome. Advances in the diagnosis and management of portal hypertension over the last year are reviewed. The measurement of the hepatic venous pressure gradient provides important prognostic information in patients with portal hypertension. Noninvasive testing with transient elastography, capsule endoscopy, and computed tomography scanning for the diagnosis of esophageal varices is promising but more information is needed. Easily obtainable clinical data have been identified in patients with acute variceal bleeding that provides important information in determining initial response to therapy and prognosis. New therapies for patients with dilutional hyponatremia with vasopressin antagonists are promising and may improve the management of this condition. Terlipressin is the best medical therapy currently available for the management of hepatorenal syndrome as confirmed in recent studies. Patients with advanced liver disease benefit from the long-term administration of norfloxacin as it prevents the development of hepatorenal syndrome and improves survival. The ongoing advances in the diagnosis and management of patients with cirrhosis and portal hypertension will improve the high morbidity and mortality of the complications of cirrhosisCurrent opinion in gastroenterology 06/2009; 25(3):195-201. DOI:10.1097/MOG.0b013e328329e154 · 3.66 Impact Factor
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ABSTRACT: Portal hypertension is a clinically important consequence of cirrhosis that can lead to morbidities such as variceal bleeding, hepatic encephalopathy and ascites. All of these outcomes carry high mortality rates. There have been several drugs created to assist with endoscopic therapy for the treatment of acute variceal bleeding. Recently, vapreotide has been studied in patients to evaluate its efficacy as treatment for acute variceal hemorrhage. Although no comparisons have been made between vapreotide and other somatostatin analogues, this drug has been shown to have efficacy in the control of acute variceal bleeding as well as reducing the risk of recurrent bleeding and death, especially when started prior to endoscopy. This paper reviews the literature regarding the basic science and clinical efficacy of vapreotide in acute variceal bleeding. We used a PubMed/Medline search in order to review the literature regarding the drug, vapreotide. Vapreotide appears to have benefit in the control of acute variceal bleeding. It is easy to administer and has few side effects, which are minor. These findings endorse the need for future trials to evaluate vapreotide and its use in acute variceal hemorrhage, a morbidity among patients with cirrhosis.Expert Opinion on Pharmacotherapy 09/2009; 10(14):2337-42. DOI:10.1517/14656560903207019 · 3.09 Impact Factor
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ABSTRACT: Management of acute variceal bleeding has greatly improved over recent years. Available data indicates that general management of the bleeding cirrhotic patient by an experienced multidisciplinary team plays a major role in the final outcome of this complication. It is currently recommended to combine pharmacological and endoscopic therapies for the initial treatment of the acute bleeding. Vasoactive drugs (preferable somatostatin or terlipressin) should be started as soon as a variceal bleeding is suspected (ideally during transfer to hospital) and maintained afterwards for 2-5 d. After stabilizing the patient with cautious fluid and blood support, an emergency diagnostic endoscopy should be done and, as soon as a skilled endoscopist is available, an endoscopic variceal treatment (ligation as first choice, sclerotherapy if endoscopic variceal ligation not feasible) should be performed. Antibiotic prophylaxis must be regarded as an integral part of the treatment of acute variceal bleeding and should be started at admission and maintained for at least 7 d. In case of failure to control the acute bleeding, rescue therapies should be immediately started. Shunt therapies (especially transjugular intrahepatic portosystemic shunt) are very effective at controlling treatment failures after an acute variceal bleeding. Therapeutic developments and increasing knowledge in the prognosis of this complication may allow optimization of the management strategy by adapting the different treatments to the expected risk of complications for each patient in the near future. Theoretically, this approach would allow the initiation of early aggressive treatments in high-risk patients and spare low-risk individuals unnecessary procedures. Current research efforts will hopefully clarify this hypothesis and help to further improve the outcomes of the severe complication of cirrhosis.07/2010; 2(7):261-74. DOI:10.4254/wjh.v2.i7.261