Prediction of the First Variceal Hemorrhage

To the Editor: In the article on the prediction of the first variceal hemorrhage in patients with cirrhosis (Oct. 13 issue),* the North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices used a well-designed prospective study in a large number of patients to answer an important clinical question. However, their claim that their prognostic index predicts the first variceal hemorrhage in these patients is overstated and misleading. Of the 85 patients who bled from the upper gastrointestinal tract, only 53 had endoscopically confirmed variceal bleeding. Other causes of upper gastrointestinal bleeding were identified in 4 patients, whereas… © 1989, Massachusetts Medical Society. All rights reserved.