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Prevention and Management of Variceal Hemorrhage

Title
Prevention and Management of Variceal Hemorrhage
Authors
Dong Hyun Kim;Jun Yong Park
Issue Date
2013
Journal Title
International Journal of Hepatology
ISSN
2090-3448
Citation
International Journal of Hepatology, Vol.2013(Article ID 434609) : 1~6, 2013
Abstract
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.
URI

http://ir.ymlib.yonsei.ac.kr/handle/22282913/87609
DOI
10.1155/2013/434609
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Internal Medicine
Yonsei Authors
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