Prevention and Management of Variceal Hemorrhage
Variceal hemorrhage is a common and devastating complication of portal hypertension and is a leading cause of death in patients with cirrhosis. The management of gastroesophageal varices has evolved over the last decade resulting in improved mortality and morbidity rates. Regarding the primary preve...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | International Journal of Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2013/434609 |
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| author | Dong Hyun Kim Jun Yong Park |
| author_facet | Dong Hyun Kim Jun Yong Park |
| author_sort | Dong Hyun Kim |
| collection | DOAJ |
| description | Variceal hemorrhage is a common and devastating complication of portal hypertension and is a leading cause of death in patients with cirrhosis. The management of gastroesophageal varices has evolved over the last decade resulting in improved mortality and morbidity rates. Regarding the primary prevention of variceal hemorrhaging, nonselective β-blockers should be the first-line therapy in all patients with medium to large varices and in patients with small varices associated with high-risk features such as red wale marks and/or advanced cirrhosis. EVL should be offered in cases of intolerance or side effects to β-blockers, or for patients at high-risk for variceal bleeding who have medium or large varices with red wale marks or advanced liver cirrhosis. In acute bleeding, vasoactive agents should be initiated along with antibiotics followed by EVL or endoscopic sclerotherapy (if EVL is technically difficult) within the first 12 hours of presentation. Where available, terlipressin is the preferred agent because of its safety profile and it represents the only drug with a proven efficacy in improving survival. All patients surviving an episode of bleeding should undergo further prophylaxis to prevent rebleeding with EVL and nonselective β-blockers. |
| format | Article |
| id | doaj-art-88505d9b96f446bd96e08766dce5c7a8 |
| institution | Kabale University |
| issn | 2090-3448 2090-3456 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Hepatology |
| spelling | doaj-art-88505d9b96f446bd96e08766dce5c7a82025-02-03T05:53:23ZengWileyInternational Journal of Hepatology2090-34482090-34562013-01-01201310.1155/2013/434609434609Prevention and Management of Variceal HemorrhageDong Hyun Kim0Jun Yong Park1Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, Republic of KoreaDepartment of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, Republic of KoreaVariceal hemorrhage is a common and devastating complication of portal hypertension and is a leading cause of death in patients with cirrhosis. The management of gastroesophageal varices has evolved over the last decade resulting in improved mortality and morbidity rates. Regarding the primary prevention of variceal hemorrhaging, nonselective β-blockers should be the first-line therapy in all patients with medium to large varices and in patients with small varices associated with high-risk features such as red wale marks and/or advanced cirrhosis. EVL should be offered in cases of intolerance or side effects to β-blockers, or for patients at high-risk for variceal bleeding who have medium or large varices with red wale marks or advanced liver cirrhosis. In acute bleeding, vasoactive agents should be initiated along with antibiotics followed by EVL or endoscopic sclerotherapy (if EVL is technically difficult) within the first 12 hours of presentation. Where available, terlipressin is the preferred agent because of its safety profile and it represents the only drug with a proven efficacy in improving survival. All patients surviving an episode of bleeding should undergo further prophylaxis to prevent rebleeding with EVL and nonselective β-blockers.http://dx.doi.org/10.1155/2013/434609 |
| spellingShingle | Dong Hyun Kim Jun Yong Park Prevention and Management of Variceal Hemorrhage International Journal of Hepatology |
| title | Prevention and Management of Variceal Hemorrhage |
| title_full | Prevention and Management of Variceal Hemorrhage |
| title_fullStr | Prevention and Management of Variceal Hemorrhage |
| title_full_unstemmed | Prevention and Management of Variceal Hemorrhage |
| title_short | Prevention and Management of Variceal Hemorrhage |
| title_sort | prevention and management of variceal hemorrhage |
| url | http://dx.doi.org/10.1155/2013/434609 |
| work_keys_str_mv | AT donghyunkim preventionandmanagementofvaricealhemorrhage AT junyongpark preventionandmanagementofvaricealhemorrhage |