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Current Management Strategies for Acute Esophageal Variceal Hemorrhage

  • Management of the Cirrhotic Patient (NS Reau and A Cardenas, Section editors)
  • Published:
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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.

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Acknowledgements

Grant support: NIH P-30DK 034989

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Conflict of Interest

Brett Fortune and Guadalupe Garcia-Tsao declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the authors.

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Authors and Affiliations

  1. Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street – 1080 LMP, P.O. Box 208019, New Haven, CT, 06520-8019, USA

    Brett Fortune & Guadalupe Garcia-Tsao

  2. Section of Digestive Diseases, VA-CT Healthcare System, West Haven, CT, USA

    Guadalupe Garcia-Tsao

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  1. Brett Fortune
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Correspondence to Guadalupe Garcia-Tsao.

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Fortune, B., Garcia-Tsao, G. Current Management Strategies for Acute Esophageal Variceal Hemorrhage. Curr Hepatology Rep 13, 35–42 (2014). https://doi.org/10.1007/s11901-014-0221-y

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  • DOI: https://doi.org/10.1007/s11901-014-0221-y

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