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Recommendations on the Diagnosis and Initial Management of Acute Variceal Bleeding and Hepatorenal Syndrome in Patients with Cirrhosis

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Abstract

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.

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Acknowledgment

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.

Funding

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.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, Herestraat 49, 3000, Louvain, Belgium

    Frederik Nevens

  2. Unit of Gastroenterology and Hepatology, Portuguese Hospital of Salvador, Rua Prof. Clementino Fraga, 220/1901, Salvador, Bahia, Brazil

    Paulo Lisboa Bittencourt

  3. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2300 ZC, Leiden, The Netherlands

    Minneke J. Coenraad

  4. Department of Gastroenterology and Hepatology, Beijing You’an Hospital Affiliated with Capital Medical University, No 8, Youan Men Wai Street, Fengtai District, Beijing, 100069, China

    Huiguo Ding

  5. Department of Medicine Division of Gastroenterology, Taipei Veterans General Hospital, 201, Sec. II, Shih-Pai Road, Taipei, Taiwan

    Ming-Chih Hou

  6. Medical-surgical Intensive Care Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, Brussels, Belgium

    Pierre-François Laterre

  7. Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Av. Peron 1500, 1629, Pilar, Provincia de Buenos Aires, Argentina

    Manuel Mendizabal

  8. Department of Gastroenterology, UMAE, Hospital de Especialidades Dr. Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico

    Nayeli Xochiquetzal Ortiz-Olvera

  9. Department of Gastroenterology and Hepatology, University of Rosario Medical School, Morrison 8750, 2000, Rosario, Argentina

    Julio D. Vorobioff

  10. Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Rd, Jingan Qu, Shanghai Shi, 200000, China

    Wenhong Zhang

  11. Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy

    Paolo Angeli

Authors
  1. Frederik Nevens
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  2. Paulo Lisboa Bittencourt
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  3. Minneke J. Coenraad
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  4. Huiguo Ding
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  5. Ming-Chih Hou
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  6. Pierre-François Laterre
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  7. Manuel Mendizabal
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  8. Nayeli Xochiquetzal Ortiz-Olvera
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  9. Julio D. Vorobioff
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  10. Wenhong Zhang
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  11. Paolo Angeli
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Corresponding author

Correspondence to Frederik Nevens.

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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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Nevens, F., Bittencourt, P.L., Coenraad, M.J. et al. Recommendations on the Diagnosis and Initial Management of Acute Variceal Bleeding and Hepatorenal Syndrome in Patients with Cirrhosis. Dig Dis Sci 64, 1419–1431 (2019). https://doi.org/10.1007/s10620-018-5448-y

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  • DOI: https://doi.org/10.1007/s10620-018-5448-y

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