upper gastrointestinal bleeding ia a major emergency and represents a major public health problem , its prevalence being 100170:100000 people . bleeding from esophageal varices is only 511% of all gastrointestinal bleeding and in the u.s . approximately 30% of patients with compensated cirrhosis have esophageal varices when first diagnosed . in cirrhotic patients , life prognosis in a patient with upper gi bleeding from esophageal varices depends on the severity of the bleeding , the hepatic functional reserve ( stage of cirrhosis ) , the extent and location of the varices ( esophageal or gastric ) , their age , the existence of associated diseases and the treatment prescribed . the aim of this study was to monitor the risk factors that trigger variceal bleeding in cirrhotic patients , to assess the severity of the bleeding and the efficacy of the endoscopic hemostasis techniques , to assess the relapses of bleeding episodes and the mortality rate . the study was a prospective one , and it was conducted in the period 11.200412.2006 in the o. fodor  regional institute of gastroenterology and hepatology , cluj - napoca ; 273 patients with variceal bleeding underwent upper gastrointestinal endoscopy for diagnosis and treatment in emergency conditions , at the office of digestive endoscopy of the  o. fodor  regional institute of gastroenterology and hepatology , cluj - napoca ; the study included only patients who had upper gastrointestinal bleeding because of variceal rupture , which was assessed by emergency endoscopic examination , performed within 6 hours of the patient s admission ; after identifying the variceal source of the upper gi bleeding , endoscopic therapy was performed ( elastic ligatures or endoscopic sclerotherapy with hypertonic glucose solution , depending on the possibilities under emergency conditions ) ; during periodical check - ups , the risk factors for variceal bleeding were monitored in cirrhotic patients , along with the efficacy of endoscopic treatment techniques , the relapses of bleeding episodes , the number and cause of deaths of cirrhotic patients who experienced upper gastrointestinal bleeding because of rupture of varices ; the patients included in the study met the clinical , biochemical , endoscopic and ultrasound criteria for liver cirrhosis ; the etiology and the staging of the disease were documented according to the patient s observation charts ; the results of the study were processed using excel ; quantitative data were expressed as median  se ; the study was approved by the local ethics board of the  prof . the average age of the patients included in the study was 57.86 years , the extremes being represented by 26 and 82 years ( figure 1 ) . regarding the gender distribution of patients , there were 167 male patients ( 61.17% ) and 106 female patients ( 38.83% ) . out of the 273 cases with variceal bleeding , 255 ( 93.4% ) were cases of bleeding from esophageal varices and 18 ( 6.6% ) were cases of gastric varices . thus , it occurs more frequently in patients with varices grade ii and iii . in our series there were 2 patients ( 0.73% ) with bleeding from esophageal varices grade i , 131 patients ( 47.98% ) with hemorrhage from esophageal varices grade ii and 122 patients ( 44.7% ) with bleeding from varices grade iii . gastric varices hemorrhage was found in 18 patients ( 6.59% ) ( figure 2 ) . . however , the risk of variceal rupture increases with the increased severity of the liver disease . thus , variceal bleeding occurred in 63 ( 23% ) patients in child class a , 109 ( 40% ) patients in child class b and 101 ( 37% ) patients in child class c. mortality caused by variceal hemorrhage was 2.93% in the study group . death occurred in 8 patients as follows : 1 was in child class a , 2 were in child class b and 5 in child c class . hence , the mortality of patients with variceal hemorrhage is closely related to the child class . variceal bleeding was more frequent in patients with alcoholic liver cirrhosis - 140 cases ( 51.28% ) ; the next highest frequency was in patients with c virus cirrhosis - 69 cases ( 25.27% ) , b virus liver cirrhosis - 21 cases ( 7.69% ) , followed by other etiologies - 43 cases ( 15.76% ) . some of the 273 patients with variceal bleeding also had significant comorbidities : liver carcinoma ( 45 cases ) , gastric cancer ( 2 cases ) , lung cancer ( 1 case ) , liver metastases ( 1 case ) , pregnancy 28 weeks ( 1 case ) , peritoneal carcinomatosis ( 1 case ) . initial variceal bleeding was arrested in 269 of the 273 patients admitted under emergency conditions , using endoscopic techniques for hemostasis therapy . the failure of the endoscopic techniques imposed the use of the sengstaken - blakemore probe in 4 patients . a number of 148 patients were treated by sclerotherapy and 125 patients by performing elastic ligatures . out of the 148 patients treated by sclerotherapy during the first bleeding episode , in 28 cases sclerotherapy was performed when the first bleeding relapse occurred , while in 16 cases elastic ligatures were performed . out of the 125 patients treated by elastic ligature during the first bleeding episode , in 9 cases sclerotherapy was performed when the first bleeding relapse occurred , while in 12 cases elastic ligatures were performed . three porto - caval shunt interventions were performed , in 3 male patients of 41 , 46 and 71 years of age . each of these three patients presented three episodes of variceal bleeding . in the case of the 71-year old patient bleeding recurrence occurred in 65 ( 23.8% ) patients of the study group , 43 men and 22 women ( figure 3 ) . the average age of those who experienced bleeding relapses was close to the average age of the group , which was 58.69 years . thirty - seven patients underwent endoscopic treatment by sclerosis of varices with 2 ml of hypertonic glucose in 812 points intra- and para - varices , while 28 patients underwent elastic ligatures ( 46 elastic rings ) . there were 17 cases of bleeding recurrence within 7 days of the first bleeding episode , 19 cases in the first month , 11 cases after 6 months and 18 cases after 1 year . the failure of emergency endoscopic treatment is defined as continued or recurrent bleeding within less than five days , in spite of the completion of two sessions of sclerotherapy . there are no predictors of the failure to indicate and require treatment change . in the study group there were 14 cases of bleeding relapses within the first 4 days of the endoscopic hemostasis . bleeding relapses were favored by the presence of hepatocarcinoma ( 26 patients out of the 65 patients with recurrent bleeding ) and by the child class c ( 23 patients ) . in the present study , out of the 65 patients with recurrent bleeding , 13 were not treated with propranolol while 9 were treated with small doses of propranolol . alcoholic cirrhosis was the dominant etiology in patients with recurrent bleeding ( 36 cases - 55.38% ) , while the child class c was found in 22 patients ( 33.84% ) . the results of the current study show that bleeding from esophageal varices is more frequent than from gastric varices ( 93.4% versus 6.6% ) . mention must be made that the rupture of the varices depends on the size of the variceal veins , and thus rupture is more frequent in patients with esophageal varices grade ii and iii . the data obtained in the present study are in keeping or similar to those shown in the speciality literature . variceal bleeding was more frequent in male patients , the data obtained being in keeping or similar to those shown in the specialty literature . the variceal hemorrhage prevailed in each clinical class and the variceal rupture risk increased with the increase in the severity of the liver disease . thus , the majority of patients with variceal bleeding were child class b or c ( 77% ) , our results overlapping those mentioned in literature . variceal bleeding was more frequent in patients with alcoholic liver cirrhosis ( 51.28% ) , the results being similar to those reported in literature . in the current study , 19% of the patients who had variceal bleeding also had significant comorbidities , the most frequent being hepatocarcinoma which has been reported as a significant predictive factor for death in decompensated cirrhosis and early rebleeding in several studies . bleeding relapses were frequent ( 23.8% ) and raised special problems related to the type of treatment ( sclerotherapy or ligation ) , to the therapeutic booster in order to eradicate esophageal varices , to the adjuvant medication therapy for portal hypertension ( beta - blockers ) or to invasive procedures for the treatment of portal hyper - tension ( tips ) or liver cirrhosis ( liver transplantation ) . bleeding recurred more frequently after sclerotherapy than after the application of elastic ligatures ( 29.72% versus 16.8% ) , the results of the current study being similar to those published in literature . approximately 34% of our patients experiencing bleeding relapses did not receive beta - blocker therapy or were given low - dose propranolol . for secondary prevention , a meta - analysis that compared beta - blockers plus isosorbide mononitrate versus endoscopic band ligation   showed no significant differences between treatments in preventing rebleeding or in preventing deaths . however , in trials using a mean beta - blocker dose of less than 80 mg / day , endoscopic band ligation significantly reduced rebleeding compared with beta - blockers plus isosorbide mononitrate . in addition , earlier meta - analyses usually included trials in abstract form , of which complete data were not available . therefore , a further update of studies comparing endoscopic band ligation and pharmacological therapy should be performed . the study also showed that the severity and etiology of the liver disease ( cirrhosis ) may play a role in the risk for bleeding relapses . in the study group there were three porto - caval shunt interventions , each patient presenting three bleeding relapses during the period studied . mortality due to variceal hemorrhage was 2.93% in the study group , which was lower than that in the data published in the speciality literature . many studies have reported decreasing incidence and mortality rates of variceal bleeding   by progress of treatment modalities . the significant decrease in mortality in other studies is probably due to the improvement in treatment modalities such as endoscopic treatment , transjugular intra - hepatic portosystemic shunt , and pharmacologic treatment including the use of prophylactic antibiotics and vasoactive drugs . the mortality of patients with variceal hemorrhage is closely related to the child class ( 62.5% - child c ) . however , the risk of variceal rupture increases with the increased severity of the liver disease . hence , the mortality of patients with variceal hemorrhage is closely related to the child class . variceal bleeding occurred more frequently in patients with alcoholic cirrhosis stage child c. in our study mortality was relatively low . hence , prevention methods against variceal rupture and the application of elastic ligatures are required as a means of treatment .