Chapter 138

Management of Upper Gastrointestinal Hemorrhage Related to Portal Hypertension

Tinsay A. Woreta

Tinsay A. Woreta

Johns Hopkins University, Baltimore, MD, USA

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Zhiping Li

Zhiping Li

Johns Hopkins University, Baltimore, MD, USA

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First published: 27 November 2015

Summary

Gastroesophageal variceal bleeding is one of the most serious consequences of portal hypertension and is associated with a mortality of 15–20% with each bleeding episode in patients with cirrhosis. Thus, primary prophylaxis to prevent the first episode of variceal bleeding in high risk patients is important. The main predictors of variceal bleeding are variceal size, the presence of red signs, and Child-Pugh class. Non-selective β-blocker therapy or endoscopic variceal ligation (EVL) is the treatment of choice for primary prophylaxis in patients with medium or large esophageal varices. The management of acute variceal bleeding consists of appropriate resuscitation, short-term antibiotic use, early initiation of vasoactive drugs, and emergency endoscopic therapy. EVL is the endoscopic therapy of choice as it is more effective than sclerotherapy and has fewer side effects. Secondary prophylaxis to prevent recurrent bleeding is critical given the high risk of rebleeding, and consists of combination therapy with a β-blocker and EVL.

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