Management of Upper GI Bleeding in Cirrhotic Patients

  • Alexander DechêneEmail author


Portal hypertension in patients with liver cirrhosis is the main factor contributing to the formation of esophageal or gastric varices. The risk of bleeding reflects the grade of portal hypertension and can be estimated using invasive or noninvasive methods. Primary prevention of variceal bleeding can be achieved using pharmacologic or endoscopic interventions.

Given that upper gastrointestinal hemorrhage from varices is associated with significant mortality, the major aims of acute management are hemodynamic stabilization, pharmacologic reduction of portal pressure, and endoscopic treatment of bleeding vessels, as well as prevention and treatment of concomitant infections. In patients with treatment failure, rescue options include implantation of esophageal stents and placement of transjugular intrahepatic portosystemic shunts (TIPS).

After hemostasis is achieved, the risk of rebleeding should be evaluated, as certain groups of patients benefit from early placement of TIPS whereas others can safely be managed with a combination of pharmacologic and endoscopic modalities.

Acute hemorrhage from portal hypertensive gastropathy is significantly less frequent than variceal hemorrhage and can be managed noninvasively in most patients.


Gastrointestinal bleeding Gastroesophageal varices Portal hypertensive gastropathy Portal hypertension Variceal band ligation Transjugular intrahepatic portosystemic shunt Primary prevention Secondary prevention 


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© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Gastroenterology, Hepatology, Endocrinology and Nutritional MedicineParacelsus Medical UniversityNurembergGermany

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