Variceal bleeding is associated with reduced risk of severe cholestasis in primary biliary cirrhosis

To test the hypothesis that, in primary biliary cirrhosis, bleeding from oesophageal varices implies a reduced risk that a patient will subsequently develop severe cholestasis, the case records of 76 patients with this condition who had died were examined. Fifty-nine patients (78 per cent) had died solely or largely as a consequence of liver disease. Their median survival from the onset of symptoms was 72 months. Most died from either hepatic failure with marked jaundice, infected ascites or variceal bleeding. Fifteen patients had a plasma bilirubin less than 100 mumol/l at the time of death. Twenty-eight patients had had variceal bleeding. Compared with the remaining 31 who had also died from cirrhosis, the patients who had bled from varices survived longer, were much less likely to die of hepatic failure and to become severely jaundiced but were more likely to develop fatal infected ascites.