Oesophageal varices: Assessment of the risk of bleeding and mortality

Patients with oesophageal varices run a high risk of bleeding and even deat h, however rates of bleeding and mortality vary greatly. Indeed, a number o f patients with varices never bleed. Prophylactic therapy is effective, but can be associated with side-effects. It remains to be determined which pat ients are at high risk of bleeding and require treatment. In addition, sinc e non-response to medical therapy has been reported to occur in 20-40% of p atients, the effect of a given prophylactic drug, or combinations of drugs, needs to be tested. A review is given of available methods of assessment. The Hepatic Venous Pressure Gradient, and measurements of the variceal pres sure, are two proven methods, and the latter has the advantages of being no n-invasive and having value in presinusoidal portal hypertension. (C) 2000 Blackwell Science Asia Pty Ltd.