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Declining Hospitalizations for Bleeding Esophageal Varices

Finding possibly due to prophylaxis, but study also finds increased incidence of non-bleeding varices

MONDAY, June 30 (HealthDay News) -- While the incidence of esophageal bleeding may be declining due to primary and secondary prophylaxis, the pervasiveness of portal hypertension is leading to an increased incidence of non-bleeding esophageal varices, according to an article published in the June issue of Clinical Gastroenterology and Hepatology.

M. Mazen Jamal, M.D., of the Long Beach Veterans Affairs Medical Center in Long Beach, Calif., and colleagues examined the Nationwide Inpatient Sample database and the State Ambulatory Surgery Database to evaluate the impact of primary and secondary prophylaxis on the incidence of bleeding esophageal varices, and studied incidence trends of non-bleeding esophageal varices over a 20-year period.

The researchers found that the incidence of esophageal varices (12.4 per 100,000 in 1994-1996 period) peaked in the mid-1990s and significantly declined 14.5 percent by 2000 (10.6 per 100,000 in the 2000 to 2002 period). In-hospital non-bleeding varices and outpatient non-bleeding esophageal varices increased by 55 percent (6.0 to 9.3 per 100,000) and 20 percent (5.5 to 6.6 per 100,000), respectively, during similar time periods.

The investigators conclude the declining incidence of bleeding esophageal varices is "likely a reflection of a decrease in rebleeding rates and first episodes of bleeding owing to advances in primary and secondary prophylaxis, particularly variceal band ligation" and that "the incidence rate of non-bleeding esophageal varices has been increasing in the past two decades and is likely a reflection of the increasing burden of portal hypertensive liver disease in the nation."

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