BMJ  2006;332:423 (18 February), doi:10.1136/bmj.332.7538.423

Letter

An alcoholic patient who continues to drink: endoscopic treatment is preferred

The first 150 words of the full text of this article appear below.

EDITOR—Patients like Mr Bond in the last interactive case report are increasingly common and present difficult clinical decisions.¹ Leon and McCambridge highlighted the large increase in deaths from cirrhosis in the United Kingdom between 1987-91 and 1997-2001.² Mortality doubled (104% increase) in men in Scotland during that time, and per capita alcohol consumption also doubled in the UK between 1960 and 2002. Treatment of Mr Bond's variceal haemorrhage and associated decisions on how far to go with intervention should be based on clinical need, balanced with the probability of a beneficial outcome for Mr Bond, rather than his continued drinking or other lifestyle issues.

When Mr Bond presented with a further variceal bleed he was successfully treated endoscopically. At this point a transjugular intrahepatic portosystemic shunt is not clinically indicated. Eleven randomised controlled trials have compared endoscopic treatment with a shunt for recurrent bleeding. A meta-analysis of these . . . [Full text of this article]

Freeman Hospital, Newcastle upon Tyne NE7 7DN Mark.Hudson@nuth.nhs.uk

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