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Recent advances in the management of variceal bleeding
Acute haemorrhage from ruptured gastroesophageal varices is perhaps the most serious consequence of uncontrolled portal hypertension in cirrhotic patients. It represents a medical emergency and is associated with a high morbidity and mortality. In those who survive the initial bleeding event, the ri...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421505/ https://www.ncbi.nlm.nih.gov/pubmed/28533909 http://dx.doi.org/10.1093/gastro/gox007 |
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author | Haq, Ihteshamul Tripathi, Dhiraj |
author_facet | Haq, Ihteshamul Tripathi, Dhiraj |
author_sort | Haq, Ihteshamul |
collection | PubMed |
description | Acute haemorrhage from ruptured gastroesophageal varices is perhaps the most serious consequence of uncontrolled portal hypertension in cirrhotic patients. It represents a medical emergency and is associated with a high morbidity and mortality. In those who survive the initial bleeding event, the risks of further bleeding and other decompensated events remain high. The past 30 years have seen a slow evolution of management strategies that have greatly improved the chances of surviving a variceal haemorrhage. Liver cirrhosis is a multi-staged pathological process and we are moving away from a one-size-fits-all therapeutic approach. Instead there is an increasing recognition that a more nuanced approach will yield optimal survival for patients. This approach seeks to risk stratify patients according to their disease stage. The exact type and timing of treatment offered can then be varied to suit individual patients. At the same time, the toolbox of available therapy is expanding and there is a continual stream of emerging evidence to support the use of endoscopic and pharmacological therapies. In this review, we present a summary of the treatment options for a variety of different clinical scenarios and for when there is failure to control bleeding. We have conducted a detailed literature review and presented up-to-date evidence from either primary randomized–controlled trials or meta-analyses that support current treatment algorithms. |
format | Online Article Text |
id | pubmed-5421505 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-54215052017-05-22 Recent advances in the management of variceal bleeding Haq, Ihteshamul Tripathi, Dhiraj Gastroenterol Rep (Oxf) Review Articles Acute haemorrhage from ruptured gastroesophageal varices is perhaps the most serious consequence of uncontrolled portal hypertension in cirrhotic patients. It represents a medical emergency and is associated with a high morbidity and mortality. In those who survive the initial bleeding event, the risks of further bleeding and other decompensated events remain high. The past 30 years have seen a slow evolution of management strategies that have greatly improved the chances of surviving a variceal haemorrhage. Liver cirrhosis is a multi-staged pathological process and we are moving away from a one-size-fits-all therapeutic approach. Instead there is an increasing recognition that a more nuanced approach will yield optimal survival for patients. This approach seeks to risk stratify patients according to their disease stage. The exact type and timing of treatment offered can then be varied to suit individual patients. At the same time, the toolbox of available therapy is expanding and there is a continual stream of emerging evidence to support the use of endoscopic and pharmacological therapies. In this review, we present a summary of the treatment options for a variety of different clinical scenarios and for when there is failure to control bleeding. We have conducted a detailed literature review and presented up-to-date evidence from either primary randomized–controlled trials or meta-analyses that support current treatment algorithms. Oxford University Press 2017-05 2017-04-07 /pmc/articles/PMC5421505/ /pubmed/28533909 http://dx.doi.org/10.1093/gastro/gox007 Text en © The Author(s) 2017. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-Sen University. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com. |
spellingShingle | Review Articles Haq, Ihteshamul Tripathi, Dhiraj Recent advances in the management of variceal bleeding |
title | Recent advances in the management of variceal bleeding |
title_full | Recent advances in the management of variceal bleeding |
title_fullStr | Recent advances in the management of variceal bleeding |
title_full_unstemmed | Recent advances in the management of variceal bleeding |
title_short | Recent advances in the management of variceal bleeding |
title_sort | recent advances in the management of variceal bleeding |
topic | Review Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421505/ https://www.ncbi.nlm.nih.gov/pubmed/28533909 http://dx.doi.org/10.1093/gastro/gox007 |
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