Hemorrhage from esophageal varices represents a major complication of portal hypertension and is commonly observed in patients with cirrhosis. This condition is associated with significant mortality, mainly due to the risk of recurrent bleeding, which may lead to severe complications and a poor prognosis if left untreated. The objective of this study is to analyze the factors contributing to recurrence of hemorrhage from esophageal varices, with the aim of identifying clinical and therapeutic elements that can improve prevention strategies and optimize patient management. 

This is a retrospective, descriptive, single-center study conducted over a period of 5 years (2020–2025), consecutively including patients hospitalized for recurrent upper gastrointestinal bleeding due to rupture of esophageal varices (EV), confirmed by esophagogastroduodenoscopy performed in the HepatoGastroenterology and Proctology Department “Medicine B” of Ibn Sina Hospital, Rabat. Demographic, clinical, endoscopic, and therapeutic data, as well as risk factors associated with recurrence of bleeding, were collected from patients’ medical records.

A total of 24 patients were included. The mean age was 49 ± 13 years, ranging from 26 to 80 years. A male predominance was observed, with 14 men (58.33%) versus 10 women (41.66%), resulting in a male-to-female ratio of 1.4. The majority of patients (45%) had hepatic cirrhosis (n=11), with an indeterminate etiology (64%), followed by hepatitis C (18%), alcohol-related cirrhosis (9%), and portal hypertension-related (9%). Patients classified as Child A and Child B each represented 44.4% of cases, while Child C accounted for 11.1%. The mode of gastrointestinal bleeding presentation was hematemesis in 41%, melena in 41%, and both in 16% of patients. Esophageal varices were graded as grade III in 62.5%, grade II in 29.16%, and grade I in 8.33%, with red signs observed in the majority of cases (79%). 13 patients (54%) received beta-blocker therapy after the initial hemorrhagic episode, and 12 patients (50%) underwent endoscopic variceal ligation to prevent recurrence. The time to recurrence of bleeding was measured in months, with a median of 4 months [range: 1–6.5].

Recurrence of hemorrhage from esophageal varices is multifactorial, involving hemodynamic, clinical, and therapeutic factors. Optimal management requires strict control of portal hypertension, effective secondary prophylaxis (endoscopic ligation and beta-blockers), and close endoscopic follow-up to reduce recurrence risk and improve patient survival.