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Management of bleeding varices in the elderly
S W Hosking1, N C Bird, A G Johnson
1University Department of Surgery, Royal Hallamshire Hospital, Sheffield.
BMJ (Clinical Research Ed.)
|January 21, 1989
Summary
Age should not prevent treatment for bleeding varices. A study comparing patients under and over 65 found similar survival rates after sclerotherapy, emphasizing early intervention for esophageal varices.
Area of Science:
- Gastroenterology
- Hepatology
- Clinical Medicine
Background:
- Bleeding varices are a serious complication of liver cirrhosis.
- Sclerotherapy is a common treatment for bleeding varices.
- The impact of age on treatment outcomes for bleeding varices requires further investigation.
Purpose of the Study:
- To compare the outcomes of bleeding varices treatment in patients under 65 and over 65 years old.
- To evaluate the effectiveness of active initial and maintenance sclerotherapy based on age groups.
Main Methods:
- A comparative study of 207 consecutive patients with bleeding varices.
- Patients were divided into two groups: under 65 (n=146) and over 65 (n=61).
- All patients received active initial and maintenance sclerotherapy over a seven-year period. Life table analysis was used for survival rates.
Main Results:
- Mortality from the first bleed was associated with liver disease severity, not age.
- One-year survival was 65% and two-year survival was 60% in both age groups.
- Alcoholic cirrhosis was more prevalent in younger patients, while cryptogenic cirrhosis was more common in older patients.
Conclusions:
- Age alone should not be a reason to withhold active treatment for bleeding varices.
- Early endoscopy and sclerotherapy are crucial for optimal outcomes in managing bleeding varices.
- Sclerotherapy demonstrates comparable efficacy in older and younger patients with bleeding varices.