Cirrhosis describes the end stages of chronic inflammation and progressive scarring of the liver and may lead to hepatocellular dysfunction and portal venous hypertension. Liver cirrhosis in itself is a major cause of mortality worldwide, accounting from more than 1 million deaths in 2010. Esophageal varices are common in cirrhosis such that Christensen et al. documented their occurrence in 90% of patients with cirrhosis within 10 years of follow up, 40% experiencing variceal bleeding. Acute hemorrhage from esophageal varices will classically appear as hematemesis and/or melena in patients with a history of cirrhosis. It is most often diagnosed by performance of an EGD which will reveal actively bleeding varices. Because of the high rate of morbidity and mortality associated with esophageal variceal bleeding, one must have a high index of suspicion in any patient with chronic liver disease or cirrhosis. As such, empiric management for variceal hemorrhage should be initiated any time this diagnosis is considered.
D'Amico G, Garcia-Pagan JC, Luca A, Bosch J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology 2006; 131:1611.
Kraja, B., Mone, I., Akshija, I., Kocollari, A., Prifti, S., Burazeri, G., Predictors of esophageal varices and first variceal bleeding in liver cirrhosis patients. World J Gastroenterol 2017; 23(26): 4806-4814
Garcia-Tsao G, Sanyal AJ, Grace ND, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46:922.
Prandi D, Rueff B, Roche-Sicot J, et al. Life-threatening hemorrhage of the digestive tract in cirrhotic patients. An assessment of the postoperative mortality after emergency portacaval shunt. Am J Surg 1976; 131:204.
Habib A, Sanyal AJ. Acute variceal hemorrhage. Gastrointest Endosc Clin N Am 2007; 17:223.
Mokdad AA, Lopez AD, Shahraz S, Lozano R, Mokdad AH, Stanaway J, Murray CJL, Naghavi M. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med. 2014;12:145. doi: 10.1186/s12916-014-0145-y.
Christensen E, Fauerholdt L, Schlichting P, et al. Aspects of the natural history of gastrointestinal bleeding in cirrhosis and the effects of prednisone. Gastroenterology 1981;81:944–52.
Gores GJ, Wiesner RH, Dickson ER, et al. Prospective evaluation of esophageal varices in primary biliary cirrhosis: Development, natural history and influence on survival. Gastroenterology 1989;96:1552–9.
The North Italian Endoscopic Club for the Study and Treat488 Afessa and Kubilis AJG – Vol. 95, No. 2, 2000 ment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices: A prospective multicenter study. N Engl J Med 1988;319:983–9.
Villanueva C, Colomo A, Bosch A, Concepción M, Hernandez-Gea V, Aracil C, Graupera I, Poca M, Alvarez-Urturi C, Gordillo J, Guarner-Argente C, Santaló M, Muñiz E, and Guarner C. Transfusion Strategies for Acute Upper Gastointestinal Bleeding. N Engl J Med 2013; 368:1.
Barkun AN, Bardou M, Kuipers EJ, et al. International Consensus Recommendations on the Management of Patients with Nonvariceal Upper Gastrointestinal Bleeding. Ann Intern Med. 2010; 152:101-113.
Chan WH, Khin LW, Chung YF, et al. Randomized controlled trial of standard versus high-dose intravenous omeprazole after endoscopic therapy in high-risk patients with acute peptic ulcer bleeding. Br J Surg. 2011:92(5):640.
Wells M, Chande N, Adams P, et al. Meta-analysis: vasoactive medications for the management of acute variceal bleeds. Aliment Pharmacol Ther 2012; 35:1267.
Gotzsche PC. Somatostatin or octreotide for acute bleeding oesophageal varices. Cochrane Database Syst Rev 2000; :CD000193.
Ioannou G, Doust J, Rockey DC. Terlipressin for acute esophageal variceal hemorrhage. Cochrane Database Syst Rev 2003; :CD002147.
Abid S, Jafri W, Hamid S, et al. Terlipressin vs. octreotide in bleeding esophageal varices as an adjuvant therapy with endoscopic band ligation: a randomized double-blind placebo-controlled trial. Am J Gastroenterol 2009; 104:617.
Soares-Weiser K, Brezis M, Tur-Kaspa R, et al. Antibiotic prophylaxis forcirrhotic patients with gastrointestinal bleeding. Cochrane DatabaseSyst Rev 2002:CD002907.
Banerjee S, Shen B, Baron TH, et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endo. 2008: 67(6): 791-798.
Laine L, Cook D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis. Ann Intern Med 1995; 123:280.
Escorsell A, Bosch J. Self-expandable metal stents in the treatment of acute esophageal variceal bleeding. Gastroenterol Res Pract. 2011;2011:910986. doi: 10.1155/2011/910986.
K.R. Patidar, M. Sydnor, A.J. SanyalTransjugular intrahepatic portosystemic shunt Clin Liver Dis, 18 (2014), pp. 853-876
Rikkers LF, Jin G. Emergency shunt. Role in the present management of variceal bleeding. Arch Surg 1995; 130:472.
Villeneuve JP, Pomier-Layrargues G, Duguay L, et al. Emergency portacaval shunt for variceal hemorrhage. A prospective study. Ann Surg 1987; 206:48.
Su AP, Zhang ZD, Tian BL, Zhu JQTransjugular intrahepatic portosystemic shunt versus open splenectomy and esophagogastric devascularization for portal hypertension with recurrent variceal bleedingHepatobiliary Pancreat Dis Int, 16 (2017), pp. 169-175
Yang L, Yuan LJ, Dong R, Yin JK, Wang Q, Li T, Li JB, Du XL, Lu JG. Two surgical procedures for esophagogastric variceal bleeding in patients with portal hypertension. World J Gastroenterol 2013; 19(48): 9418-9424
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