Are There Any Predictors of Bleeding from Advanced Esophageal Varices Due to Alcoholic and Non-alcoholic Etiology? - Experience from a Medical Gastroenterology Unit in a Sri Lankan Tertiary Care Hospital Center

Abstract

Purpose: Bleeding from advanced esophageal varices is a significant cause of morbidity and mortality in both alcoholic and non alcoholic liver disease. If predictors of bleeding could be identified, active intervention could be planned, beforehand to offer primary prophylactic banding ligation. The following study has evaluated the routine laboratory parameters in both groups, which could help to identify such high risk patients for early intervention. Methods: Case notes of 190 patients admitted to the principal author's unit at SJGH, Kotte, Sri Lanka from 01.11.2003 to 30.09.2008 (5 years) suffering from either alcoholic or non alcoholic cirrhosis who had undergone primary or secondary prophylactic banding for advanced oesophageal varices were retrospectively analyzed. Results: Total population comprised 165 males and 25 females. The subgroup with secondary banding had the following characteristics. Mean age 58.2±11.6, male: female ratio 96:15, alcoholics: non alcoholics ratio 81:30. The same characteristics for the subgroup with primary banding were as follows. Mean age 56.3±12.0, male: female ratio 69:10, alcoholics: non alcoholics ratio 58:21.The comparison of the parameters in the table shows that there were no statistically significant differences of the routine investigations performed in such patients. Conclusion: There were no laboratory parameters, which would identify high risk patients, who will bleed from esophageal varices. It seems to be rational to perform upper gastrointestinal endoscopy surveillance in all patients having diagnosed chronic liver disease, to offer primary prophylactic banding ligation of varices, at the appropriate time, as the only viable option, to prevent bleeding. Hepatic transaminases do not serve as a guide to the severity of hepatic dysfunction.Table: Demographic and biochemical parameters between patients who have undergone primary and secondary banding