Current Management Strategies for Acute Esophageal Variceal Hemorrhage
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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.
KeywordsCirrhosis 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
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Conflict of Interest
Brett Fortune and Guadalupe Garcia-Tsao declare that they have no conflicts of interest.
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This article does not contain any studies with human or animal subjects performed by the authors.
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