Trends in Variceal Bleeding: Aetiology, Demographics, and Outcomes Over Two Periods (2010-2013 vs. 2020-2023) in a Tertiary Care Centre

Aims Acute variceal bleeding is one of the most serious complications of liver cirrhosis with an incidence of up to 20% of upper gastrointestinal bleeding cases and high mortality. The aim of this study was to illustrate the presentation and characteristics of patients with acute variceal bleeding in our tertiary care centre and to present the clinical outcomes.

Methods This is a retrospective observational cohort study on 105 patients treated from 2010 to 2013 (Group A) and 38 patients treated from 2020 to 2023 (Group B). Analysed data was retrieved from electronic medical records. The recorded clinical outcomes were 30-day rebleeding, 30-day all-cause mortality, blood transfusion requirement and length of hospitalization. A p-value less than 0,05 was considered to be significant.

Results There was a significant reduction in incidence of acute variceal bleeding cases between two time periods (p<0,001). The mean age of patients from both groups was similar. Significantly more patients from Group A had variceal aetiology linked to alcohol use (90,5% vs 63,2%, p<0,001). Primary haemostasis was achieved in 90,5% of Group A patients as opposed to 100% of Group B patients (p=0,049). A similar proportion of patients received vasoactive treatment (83.8% and 71.1% respectively). Proton pump inhibitors were given to 94.6% of Group B patients as opposed to only 24.8% of Group A patients (p<0,001). For secondary prophylaxis all Group B patients underwent EBL, whereas in Group A, 42.6% underwent EBL, 20.2% mini loop ligation and 2,1% were treated with cyanoacrylate injection. Blood transfusion was given to 84.8% Group A patients and 65.8% Group B patients (p=0,013). Fresh frozen plasma was given to 70.5% Group A patients and 39.5% Group B patients (p<0,001). Group A patients received more blood (1035±578 mL vs. 541±595 mL, p<0.001) and more fresh frozen plasma (689±323 mL vs. 194±253 mL, p<0.001). The 30-day rebleeding and mortality rates were 11,4% and 19.0% for Group A, respectively and 5,3% and 11,2% for Group B, respectively. Patients spent a median of 6 or 8 days in hospital, for Group A and B, respectively.

Conclusions There was a significant decrease in the incidence of variceal bleeding between the two time periods. A smaller proportion of cases in the recent group were linked to alcohol. Primary haemostasis was achieved more frequently in the recent group, and there was a significant shift in the choice of endoscopic treatment. Patients in the recent group received blood and plasma transfusions less frequently and in smaller volumes. The 30-day rebleeding and mortality rates were lower in Group B.

Publication History

Article published online:
27 March 2025