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Influence of variceal bleeding on natural history of ACLF and management options

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Abstract

Patients with diagnosed and undiagnosed chronic liver diseases experience one or more acute assaults of a hepatic nature and develop a downhill course of liver diseases, a condition regarded as acute-on-chronic liver failure (ACLF). It is a medical emergency, the prognosis of ACLF is extremely bad and considerable numbers of patients with ACLF die even after diagnosis and receiving conservative treatment. ACLF is characterized by jaundice, coagulopathy, ascites and encephalopathy. ACLF patients are very sick and associated with different hemodynamic profiles and have very high 3-month mortality. As these groups of patients have high baseline hepatic venous pressure gradients, the chances of variceal bleed are also high, and the impact is also greater in comparison to stable cirrhosis; however, evidence is lacking to substantiate such effects. The aim of this review is to discuss the natural course of variceal bleeding in ACLF patients and to develop insights into the management of variceal bleeding in ACLF.

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Authors and Affiliations

  1. Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

    Mamun Al-Mahtab

  2. Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan

    Sheikh Mohammad Fazle Akbar

  3. Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India

    Hitendra Garg

Authors
  1. Mamun Al-Mahtab
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  2. Sheikh Mohammad Fazle Akbar
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  3. Hitendra Garg
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Correspondence to Mamun Al-Mahtab.

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Mamun Al-Mahtab, Sheikh Mohammad Fazle Akbar and Hitendra Garg declare that they have no conflict of interest.

This article does not contain any studies with human or animal subjects.

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Al-Mahtab, M., Akbar, S.M.F. & Garg, H. Influence of variceal bleeding on natural history of ACLF and management options. Hepatol Int 10, 436–439 (2016). https://doi.org/10.1007/s12072-015-9677-2

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  • DOI: https://doi.org/10.1007/s12072-015-9677-2

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