Analysis of Seasonal Variation and Risk factors of Esophageal Variceal Bleeding in Patients with Cirrhosis

Background/Aims: The circadian variation of portal blood pressure and diurnal incidence of esophageal variceal bleeding (EVB) is well known, but the seasonal variation of EVB is still controversal. This study was performed retrospectively to evaluate the seasonal variation of EVB in patients with liver cirrhosis. Methods: Three hundred and seventy-five liver cirrhotic patients with EVB were enrolled. We evaluated the seasonal variation of EVB and correlations between bleeding and other clinical factors including recent alcohol intake. Results: The incidence of EVB was highest in April (50% higher than the monthly average), followed by March and lowest in July and August (45.8% lower than the monthly average), which did not reach statistical significance. The pattern of seasonal variation in patients with a history of recent alcohol intake was similar to that in the overall patient population, whereas the incidence of EVB was highest in December and lowest in August in patients without a history of recent alcohol intake. This may indicate that a history of recent alcohol intake is an important factor for EVB. Other factors such as age and Child-Pugh classification did not correlate with the seasonal variation of EVB. Conclusions: There seems to be a seasonal variation of EVB in patients with liver cirrhosis and alcohol intake may affect this seasonal variation. This result could be explained by the fact that the spring is a busy farming season and suitable for drinking in a rural district.