gastrointestinal disorders
Varices
Prognosis for Varices
In about 40% of patients, variceal bleeding stops spontaneously. Previously, mortality was>50%, but even with current management, mortality is at least 20% at 6 weeks. Mortality depends primarily on severity of the associated liver disease rather than on the bleeding itself. Bleeding is often fatal in patients with severe hepatocellular impairment (eg, advanced cirrhosis), whereas patients with good hepatic reserve usually recover. Surviving patients are at high risk of further variceal bleeding; typically, 50 to 75% have recurrence within 1 to 2 years. Ongoing endoscopic or drug therapy (ie, endoscopic banding or nonselective beta-blockers) significantly lowers this risk, but the overall effect on long-term mortality seems to be marginal, probably because of the underlying hepatic disease. 