title: A fourfold increase of oesophageal variceal bleeding in cirrhotic patients with a history of oesophageal variceal bleeding.
abstract: BACKGROUND
  Large, recent population-based data for evaluating the predictors of oesophageal variceal bleeding (OVB) among cirrhotic patients is still lacking. This study aimed to determine the cumulative incidence of OVB among cirrhotic patients and identify the predictors of OVB occurrence.
  
  
  METHODS
  Patient information on 38,172 cirrhotic patients without a history of OVB, who were discharged between 1 January 2007 and 31 December 2007, was obtained from the Taiwan National Health Insurance Database for this study. All patients were followed up for three years. Death was the competing risk when calculating the cumulative incidences and hazard ratios (HRs) of OVB.
  
  
  RESULTS
  OVB was present in 2,609 patients (OVB group) and absent in 35,563 patients (non-OVB group) at hospitalisation. During the three-year follow-up period, the cumulative incidence of OVB was 44.5% and 11.3% in the OVB and non-OVB group, respectively (p < 0.001). Modified Cox regression analysis showed that the HR of OVB history was 4.42 for OVB occurrence (95% confidence interval [CI] 4.13-4.74). Other predictors for OVB occurrence included hepatocellular carcinoma (HR 1.16, 95% CI 1.09-1.24), young age (HR 0.98, 95% CI 0.98-0.98), ascites (HR 1.46, 95% CI 1.37-1.56), alcohol-related disorders (HR 1.20, 95% CI 1.12-1.28), peptic ulcer bleeding (HR 1.26, 95% CI 1.13-1.41) and diabetes mellitus (HR 1.14, 95% CI 1.06-1.23).
  
  
  CONCLUSIONS
  Cirrhotic patients have a fourfold increased risk of future OVB following the first incidence of OVB.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.|School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Tsung-Hsing
authors.initials: TH
authors.lastname: Hung
authors.affiliation: Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.|School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Tseng
authors.affiliation: Department of Mathematics, Tamkang University, Tamsui, Taiwan.
authors.forename: Chih-Chun
authors.initials: CC
authors.lastname: Tsai
authors.affiliation: School of Medicine, Tzu Chi University, Hualien, Taiwan.|Division of Infectious Disease, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.
authors.forename: Chorng-Jang
authors.initials: CJ
authors.lastname: Lay
authors.affiliation: School of Medicine, Tzu Chi University, Hualien, Taiwan.|Division of Infectious Disease, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.
authors.forename: Chen-Chi
authors.initials: CC
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D001201:Ascites / Q000150:complications; D006528:Carcinoma, Hepatocellular / Q000150:complications; D016208:Databases, Factual; D048909:Diabetes Complications; D004932:Esophageal and Gastric Varices / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology*; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D013624:Taiwan
keywords: cirrhosis; epidemiology; oesophageal variceal bleeding; portal hypertension