Portal hypertension and variceal bleeding-Unresolved issues. Summary of an American Association for the study of liver diseases and European Association for the study of the liver single-topic conference (original) (raw)

A. Natural History of Varices/Variceal Hemorrhage There are two main stages in the natural history of cirrhosis: compensated and decompensated cirrhosis, defined by the absence or presence of ascites, variceal hemorrhage, encephalopathy, or jaundice. 8,9 Both entities differ in clinical presentation, outcome, mortality, and predictors of death. Compensated cirrhosis has a median survival of more than 12 years (while remaining in the compensated stage), which is significantly longer than that of decompensated patients (approximately 2 years). Compensated patients die mostly after decompensation or of causes unrelated to liver disease, whereas in patients with decompensated cirrhosis mortality is mostly liver-related. Transition from a compensated to a decompensated stage is the most common outcome in patients with compensated cirrhosis and occurs at a rate of 5%-7% per year. 8,10 Although the Child-Turcotte-Pugh (CTP) score (or its components) is the most robust predictor of death in cirrhosis (compensated or decompensated), other prognostic markers differ, depending on the stage of cirrhosis. 9 In compensated cirrhosis, markers of portal hypertension (varices, platelet count, spleen size, gamma-globulins) are predictive of death, whereas in decompensated cirrhosis, markers of