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. 2014 Mar 1;13(1):35-42.
doi: 10.1007/s11901-014-0221-y.

Current Management Strategies for Acute Esophageal Variceal Hemorrhage

Brett Fortune  1 , Guadalupe Garcia-Tsao  2
Affiliations

Current Management Strategies for Acute Esophageal Variceal Hemorrhage

Brett Fortune et al. Curr Hepatol Rep. .

Abstract

Acute esophageal variceal hemorrhage is one of the clinical events that define decompensated cirrhosis and is associated with high rates of morbidity and mortality. Although recent treatment strategies have led to improved outcomes, variceal hemorrhage still carries a 6-week mortality rate of 15-20%. Current standards in its treatment include antibiotic prophylaxis, infusion of a vasoactive drug and endoscopic variceal ligation. The placement of a transjugular intrahepatic portosystemic shunt (TIPS) is considered for patients that have treatment failure or recurrent bleeding. Recurrent hemorrhage is prevented with the combination of a non-selective beta-blocker and endoscopic variceal ligation. These recommendations however assume that all patients with cirrhosis are equal. Based on a review of recent evidence, a strategy in which patients are stratified by Child class, the main predictor of outcomes, is proposed.

Keywords: Cirrhosis; carvedilol; esophageal stent; esophageal variceal ligation; hemorrhage control; nonselective beta-blockers; octreotide; portal hypertension; prophylactic antibiotics; recurrent hemorrhage; risk stratification; secondary prophylaxis; transjugular intrahepatic portosystemic stent; variceal hemorrhage.

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Conflict of interest statement

Compliance with Ethics Guidelines: Conflict of Interest: Brett Fortune and Guadalupe Garcia-Tsao declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1. Management of Acute Esophageal Variceal Hemorrhage – Standard of Care
Figure 2
Figure 2. Management of acute esophageal variceal hemorrhage – Strategy for the future?
See this image and copyright information in PMC

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