Upper gastrointestinal bleeding in cirrhosis: clinical and endoscopic correlations.

Background Acute variceal bleeding (AVB) is a medical emergency and associated with a mortality of 20% at 6 weeks. Significant advances have occurred in the recent past and hence there is a need to update the existing consensus guidelines. There is also a need to include the literature from the Eastern and Asian countries where majority of patients with portal hypertension (PHT) live. MethodsThe expert working party, predominantly from the Asia-Pacific region, reviewed the existing literature and deliberated to develop consensus guidelines. The working party adopted the Oxford system for developing an evidence-based approach. Only those statements that were unanimously approved by the experts were accepted. Results AVB is defined as a bleed in a known or suspected case of PHT, with the presence of hematemesis within 24 h of presentation, and/or ongoing melena, with last melanic stool within last 24 h. The time frame for the 123Hepatol Int (2011( ) 5:607-624 DOI 10.1007 AVB episode is 48 h. AVB is further classified as active or inactive at the time of endoscopy. Combination therapy with vasoactive drugs (\30 min of hospitalization) and endoscopic variceal ligation (door to scope time \6 h) is accepted as first-line therapy. Rebleeding (48 h of T 0 ) is further sub-classified as very early rebleeding (48 to 120 h from T 0 ), early rebleeding (6 to 42 days from T 0 ) and late rebleeding (after 42 days from T 0 ) to maintain uniformity in clinical trials. Emphasis should be to evaluate the role of adjusted blood requirement index (ABRI), assessment of associated comorbid conditions and poor predictors of nonresponse to combination therapy, and proposed APASL (Asian Pacific Association for Study of the Liver) Severity Score in assessing these patients. Role of hepatic venous pressure gradient in AVB is considered useful. Antibiotic (cephalosporins) prophylaxis is recommended and search for acute ischemic hepatic injury should be done. New guidelines have been developed for management of variceal bleed in patients with non-cirrhotic PHT and variceal bleed in pediatric patients. Conclusion Management of acute variceal bleeding in Asia-Pacific region needs special attention for uniformity of treatment and future clinical trials.

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“…Remaining 30% is due to other causes, like portal hypertensive vasculopathies, Mallory Weiss lesions and ulcers [7,8].…”

Section: Definitions Of Avb and Related Statesmentioning

confidence: 99%

Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations

et al. 2011

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“…170, Addenbrooke's Hospital, Cambridge, CB2 2QQ. [7], "acute mucosal lesions" [8], "alcoholic gastritis" etc. [29] the term portal hypertensive gastropathy (PHG) is currently accepted to describe the gastric mucosal lesions responsible for this condition [10].…”

Section: Introductionmentioning

confidence: 99%

“…The precise mechanisms responsible for PHG are incompletely understood but portal hypertension is considered to be an essential prerequisite [11][12][13]. Injection sclerotherapy has been reported to exacerbate portal hypertensive gastropathy, [5][6][7][8][9][10][11][12][13][14]15] …”

Section: Introductionmentioning

confidence: 99%

Do Alterations in the Rate of Gastric Emptyingafter Injection Sclerotherapy for OesophagealVarices Play any Role in the Developmentof Portal Hypertensive Gastropathy?

et al. 1998

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Bleeding from portal hypertensive gastropathy (PHG) has been estimated to account for upto 30% of all upper gastrointestinal haemorrhage in patients with cirrhosis and portal hypertension. Although portal hypertension seems to be an essential prerequisite, the precise mechanisms responsible for the development of PHG are unknown. The aim of this study was to examine the role of injection sclerotherapy of oesophageal varices in the development of PHG. Gastric emptying was studied using a radionuclide test meal with the emptying characteristics of a slow liquid in 57 patients with cirrhosis and/or portal hypertension (

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“…For many years, diffuse gastric bleeding in these pa tients had been included under the term of hemorrhagic gastritis [1], Several recent studies [2,3] have described apparently dis tinctive endoscopic features in portal hyper tensive patients with gastric mucosal hemor rhage. which we name 'portal hypertensive gastropathy' (PHG).…”

mentioning

confidence: 99%

“…1). It has been observed that PHG is present in about 60% of cirrhotic patients [3][4][5] and that 'severe gastropathy' is associated with a consider able risk of chronic or overt bleeding, proba bly the second source of hemorrhage in pa tients with hepatic cirrhosis [1,[5][6][7][8][9].…”

mentioning

confidence: 99%

Portal Hypertensive Gastropathy

Pérez-Ayuso

Piqué²

1991

Dig Dis

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Upper gastrointestinal bleeding in cirrhosis: clinical and endoscopic correlations.

Cited by 71 publications

References 10 publications

Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations

Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations

Do Alterations in the Rate of Gastric Emptyingafter Injection Sclerotherapy for OesophagealVarices Play any Role in the Developmentof Portal Hypertensive Gastropathy?

Portal Hypertensive Gastropathy

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