Recommendations on the Diagnosis and Initial Management of Acute Variceal Bleeding and Hepatorenal Syndrome in Patients with Cirrhosis
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Cirrhosis is a serious and life-threatening condition which imposes a significant socioeconomic burden on affected individuals and healthcare systems. Cirrhosis can result in portal hypertension, which may lead to major complications, including acute variceal bleeding and hepatorenal syndrome. Without prompt treatment, these complications may be life-threatening. Over the past 2 decades, new treatment modalities and treatment strategies have been introduced, which have improved patients’ prognosis, but the initial management of these severe complications continues to present a challenge. The present recommendations aim to increase clinicians’ knowledge on the importance of early diagnosis and treatment, and to provide evidence-based management strategies to potentially, further improve patient outcomes. Special attention was given to the role of terlipressin. A comprehensive non-systematic literature search was undertaken to evaluate the evidence for the diagnosis and initial management of acute variceal bleeding and hepatorenal syndrome in patients with cirrhosis. Recommendations on the diagnosis and initial management of acute variceal bleeding and hepatorenal syndrome in patients with cirrhosis have been developed based on the best available evidence and the expert opinion of the consensus panel following a comprehensive review of the available clinical data. Prompt identification and timely treatment of acute variceal bleeding and hepatorenal syndrome are essential to reduce the burden.
KeywordsAcute variceal bleeding Acute kidney injury Hepatorenal syndrome Cirrhosis Terlipressin Vasoactive drugs
In China, this study was supported by the State Key Projects Specialized on Infectious Diseases (2017ZX10203202-004) and Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding (ZYLX201610) for Dr Huiguo Ding.
The study was sponsored by Ferring Pharmaceuticals. The manuscript was written by Strategen Ltd, who received funding from Ferring Pharmaceuticals in this regard. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole and have given final approval to the version to be published. Ferring Pharmaceuticals reviewed the manuscript but editorial control rested solely with the authors.
Compliance with ethical standards
Conflicts of interest
Frederik Nevens has received a consultancy grant from Ferring. Manuel Mendizabal has received payments for lectures from Bristol-Myers Squibb, AbbVie, Gilead, Ferring and Bayer; honoraria for consulting from Ferring and Gilead. Paolo Angeli declares the following: 2014–2018: Sequana Medical AG Advisory Board; 2016–2018: Biovie Advisory Board and patent application; 2016 Gilead (Italy): Advisory board and grant; 2014 Bhering: travel grant; 2016 Kedrion: speaker invitation. Paulo Lisboa Bittencourt, Minneke J Coenraad, Huiguo Ding, Ming-Chih Hou, Pierre-François Laterre, Nayeli Xochiquetzal Ortiz-Olvera, Julio D. Vorobioff, Wenhong Zhang declare that they have no conflict of interest.
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