J Gastroenterol 2004; 39:1085–1089 DOI 10.1007/s00535-004-1447-1 Earlier recurrence of esophageal varices, following therapy, in patients with primary biliary cirrhosis (PBC) compared with non-PBC patients Eiji Takeshita 1 , Hidetaka Matsui 1 , Naozumi Shibata 1 , Shinya Furukawa 1 , Tomoyuki Yokota 1 , Hidehiro Murakami 1 , Yoshiou Ikeda 2 , Yoichi Hiasa 1 , Bunzo Matsuura 1 Kojiro Michitaka 2 , and Morikazu Onji 1 1 Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu-Cho, Ehime 791-0295, Japan 2 Endoscopy Center, Ehime University School of Medicine, Ehime, Japan Introduction Primary biliary cirrhosis (PBC) is characterized by a chronic, nonsuppurative, destructive cholangitis, which can lead to cirrhosis. The pathogenesis of PBC has not yet been elucidated, but several reports have indicated that an autoimmune mechanism is involved in this process. It is well known that esophageal varices are observed not only in patients with viral and alcoholic liver cirrhosis but also occasionally in patients with noncirrhotic-stage PBC. In fact, several researchers have reported that portal hypertension is a recognized complication of early-stage PBC, and several hypoth- eses for the pathogenesis of portal hypertension have been suggested, including compression of the portal venous branch by granulomatous inflammation, result- ing in presinusoidal portal hypertension, perisinusoidal fibrosis, and nodular regenerative hyperplasia. 1–3 Fur- thermore, several reports have suggested that the exist- ence of esophageal varices in patients with PBC is a significant factor in the assessment of disease progno- sis. 4–6 Although portal hypertension has previously been reported as one of the complications of PBC, 7–9 there have been no reports on the recurrence of esophageal varices after treatment in PBC patients. The aim of this study was to determine whether recurrence of esophageal varices happens earlier in PBC patients than in non-PBC patients, and to identify any clinical, biochemical, or hematological predictive factors for the recurrence of esophageal varices in patients with PBC. Patients and methods Over the past 10 years (April 1993 to August 2003), 138 (96 men and 42 women, age, 33–83 years; mean, 62.6  10.1 years) patients with esophageal varices treated in our hospital by endoscopic variceal ligation (EVL 10 ) Background. Variceal bleeding is a common, life- threatening complication of primary biliary cirrhosis (PBC). Recently, several reports have suggested that the existence of esophageal varices in patients with PBC is a significant factor in the assessment of disease prog- nosis. However, there have been no reports on the re- currence of esophageal varices following treatment in patients with PBC. In this study, we investigated the recurrence of esophageal varices in PBC patients and attempted to identify predictive factors for the recur- rence of esophageal varices. Methods. Between April 1993 and August 2003, 138 patients with esophageal varices who had been treated by endoscopic variceal ligation (EVL; 96 men and 42 women; age, 33–83 years; mean, 62.6  10.1 years), were enrolled in the present study. The diagnosis of esophageal varices was made by upper gastrointestinal endoscopy, and the varices were graded according to the criteria of the Japanese Re- search Society for Portal Hypertension. The relation- ship between the recurrence of esophageal varices and factors such as biochemical and hematological param- eters, as well as the etiology of the liver disease, was analyzed using the Kaplan-Meier method and the mul- tivariate Weibull regression model. Results. PBC pa- tients had an earlier recurrence of esophageal varices compared to non-PBC patients, and two factors, pro- thrombin time and etiology (PBC/non-PBC), were in- dicative of significantly earlier recurrence of esophageal varices. Conclusions. We should be extra careful in the follow-up of patients with PBC after therapy for esoph- ageal varices. Key words: esophageal varices, recurrence, primary bil- iary cirrhosis Received: November 27, 2003 / Accepted: April 27, 2004 Reprint requests to: M. Onji