1.   Variceal haemorrhage in cirrhotic patients carries a high early mortality even when balloon tamponade or emergency sclerotherapy are applied.

2.   The aim of this study to identify patients dying within six weeks of their first variceal haemorrhage.

3.   No consensus seems to exist in the literature for the identification of risk factors having the best prognostic value for early mortality after variceal haemorrhage.

4.   First, the absence of rigorous endoscopic criteria for defining variceal haemorrhage or indications for sclerotherapy could be two explanations for the discrepancies.

5.   As emphasised by Burroughs et al, changing the starting point for analysis after variceal haemorrhage leads to completely different conclusions.

6.   Clinical indications included encephalopathy, recurrent variceal haemorrhage unresponsive to therapy, repeated episodes of bacterial peritonitis or intractable ascites.

7.   Terlipressin and somatostatin have been advocated as effective drugs in the management of acute variceal haemorrhage but there are no published reports of their use specifically in the elderly.

8.   In addition to the problems of managing variceal haemorrhage, care and attention must be directed to other aspects of the liver.

9.   Thus an impaired conscious level frequently complicates variceal haemorrhage, and hepatic encephalopathy may be difficult to distinguish from a cerebro-vascular accident.