Management of Upper Gastrointestinal Hemorrhage Related to Portal Hypertension
Daniel K. Podolsky MD
President, University of Texas Southwestern Medical Center, Professor of Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
Search for more papers by this authorMichael Camilleri MD
Executive Dean for Development, Atherton and Winifred W. Bean Professor, Professor of Medicine, Physiology and Pharmacology, Distinguished Investigator, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorJ. Gregory Fitz MD FAASLD
Executive Vice President for Academic Aff airs and Provost, University of Texas Southwestern Medical Center, Dean, Professor of Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
Search for more papers by this authorAnthony N. Kalloo MD
Professor of Medicine, Johns Hopkins University School of Medicine, Director, Division of Gastroenterology & Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA
Search for more papers by this authorFergus Shanahan MD
Professor and Chair, Department of Medicine, Director, Alimentary Pharmabiotic Centre, University College Cork, National University of Ireland, Cork, Ireland
Search for more papers by this authorTimothy C. Wang MD
Chief, Division of Digestive and Liver Diseases, Silberberg Professor of Medicine, Department of Medicine and Irving Cancer Research Center, Columbia University Medical Center, New York, NY, USA
Search for more papers by this authorSummary
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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