Current Hepatology Reports

, Volume 13, Issue 1, pp 35–42 | Cite as

Current Management Strategies for Acute Esophageal Variceal Hemorrhage

Management of the Cirrhotic Patient (NS Reau and A Cardenas, Section editors)


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.


Cirrhosis Portal hypertension Variceal hemorrhage Risk stratification Hemorrhage control Prophylactic antibiotics Octreotide Esophageal variceal ligation Esophageal stent Transjugular intrahepatic portosystemic stent Recurrent hemorrhage Secondary prophylaxis Nonselective beta-blockers Carvedilol 



Grant support: NIH P-30DK 034989

Compliance with Ethics Guidelines

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.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  1. 1.Section of Digestive DiseasesYale University School of MedicineNew HavenUSA
  2. 2.Section of Digestive Diseases, VA-CT Healthcare SystemWest HavenUSA

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