Clin Endosc.  2020 Mar;53(2):189-195. 10.5946/ce.2019.094.

Seasonal Impacts on the Incidence of Esophageal Variceal Hemorrhage: A Nationwide Analysis across a Decade

  • 1Department of Gastroenterology and Hepatology, Center for Human Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
  • 2Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
  • 3Department of Gastroenterology, Henry Ford Medical Center, Detroit, MI, USA
  • 4Department of Internal Medicine, New York Medical College, Valhalla, NY, USA
  • 5Department of Gastroenterology, New York Medical College, Valhalla, NY, USA


Seasonal variation has previously been reported in relation to the incidence of non-variceal upper gastrointestinal bleeding; however, the impact of seasonal variation on variceal bleeding is not known.
We conducted a cross-sectional study using the Nationwide Inpatient Sample database from 2005 to 2014. International Classification of Diseases, Clinical Modification- 9th Revision codes were used to identify patients hospitalized with a primary or secondary diagnosis of esophageal variceal hemorrhage. The data were analyzed based on the month of hospitalization. Our primary aim was to assess seasonal variations in variceal bleeding-related hospitalizations. The secondary aims were to assess the impact of seasonal variation on outcomes in variceal bleeding including in-hospital mortality and healthcare resource utilization.
A total of 348,958 patients hospitalized with esophageal variceal bleeding were included. The highest number of hospitalizations was reported in December (99.3/day) and the lowest was reported in June (90.8/day). In-hospital mortality was highest in January (11.5%) and lowest in June (9.8%). There was no significant difference in hospital length of stay or total hospitalization costs across all months in all years combined.
There appears to be a seasonal variation in the incidence and mortality of variceal hemorrhage in the United States. December was the month with the highest number of daily hospitalizations while the nadir occurred in June.


Variceal bleeding; Seasonal variation; In-hospital mortality; National in-patient sample database
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