Introduction and Survey Results

Abstract

Cirrhosis is an entity composed of different prognostic stages. In compensated patients, the presence of varices identifies patients with a higher probability of decompensation, not only variceal hemorrhage but also ascites and encephalopathy. Variceal hemorrhage can occur in the absence of other decompensating events or may occur in patients who are already decompensated (presence of ascites or encephalopathy) or who develop one of these complications during the episode of variceal hemorrhage. These different scenarios have a different prognosis and should be taken into account in the treatment and investigation of patients with variceal hemorrhage. It is uncertain whether current therapies to prevent recurrent variceal hemorrhage have a different efficacy depending on the presence or absence of other decompensating events. Therapies used to prevent recurrent variceal hemorrhage may have an impact on the course of other complications of cirrhosis. Conversely, therapies used to treat other complications of cirrhosis may have an impact (negative or positive) on the course of a patient that has bled from varices. Because we now understand that variceal hemorrhage and its recurrence must be taken in the context of the presence (or absence) of other complications of cirrhosis, specific therapies and endpoints of trials to prevent recurrent variceal hemorrhage need to be readdressed and redefined.