"Variceal Hemorrhage from Esophageal Varices Associated with Alcoholic Liver Disease" (Emergency, February) was of special interest to me. I was diagnosed with primary sclerosing cholangitis when I was five years old. I'm now in my last year of nursing school.

I want to remind all nurses that even though it's probably safe to assume that the majority of esophageal varices and portal hypertension cases are indeed alcohol-related, cirrhosis and other liver diseases can occur independent of alcohol use. The literature almost always associates liver diseases with alcohol use, yet I wonder if this relationship is emphasized simply because serious diseases are easier to contemplate when there is an obvious cause.

Now in my 20s and no longer receiving pediatric care, I've started to encounter the terrible stigma associated with liver disease. On two occasions, nurses have glanced at my chart and wanted to know why I chose to "drink my life away." (I've never had alcohol.)

Please remember that many of us with this terrible condition came by it innocently. We must be careful not to label patients as alcoholics just because they suffer from liver disease, esophageal varices, or portal hypertension.

Amanda Goodwin

Munroe Falls, OH