The prevalence of gastroesophageal varices and gastrointestinal hemorrhage was determined in 124 patients with severe chronic active liver disease (CALD) receiving prednisone and followed regularly for up to 10 yr. Varices were demonstrated by contrast radiography in only 19 patients (15%). Ten had varices before therapy and nine developed them after 12-102 mo of observation (mean, 38 +/- 9 mo.). The likelihood of developing varices within 5 yr after therapy was 8% in all patients and 13% after documentation of cirrhosis. Hemorrhage from varices occurred in only 1 patient, who had varices and bled once before treatment. Bleeding from other sites was commoner in the presence of varices (P less than 0.025), but mortality was not increased by bleeding from any site. The probability of upper gastrointestinal bleeding was only 6% within 5 yr after therapy and the 5 yr survival was 93%. In severe CALD, varices are an uncommon initial finding and do not develop quickly or hemorrhage early after steroid therapy.