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Variceal hemorrhage is a lethal complication of cirrhosis, particularly in patients in whom clinical decompensation (i.e., ascites, encephalopathy, a previous episode of hemorrhage, or jaundice) has already developed.
Practice guidelines for the management of varices and variceal hemorrhage1 in cirrhosis are mostly based on evidence in the literature that has been summarized and prioritized at consensus conferences.
Drs Guadalupe Garcia-Tsao and Jaime Bosch from Spain reviewed the management of varices and variceal hemorrhage in cirrhosis.
The research team identified 3 main areas of management.
 | | The team recommend risk stratification for patients with portal hypertension | | New England Journal of Medicine |
The team examined primary prophylaxis to prevent a first episode of variceal hemorrhage, treatment of the acute bleeding episode, and secondary prophylaxis.
Gastroesophageal varices are present in almost half of patients with cirrhosis.
The team report on the pathophysiology and pathophysiological bases of therapy.
In addition, the team investigated therapies that reduce portal pressure, and local therapies without portal pressure–reducing effects.
The team recommended risk stratification for patients with portal hypertension.
Dr Garcia-Tsao's team commented, "We investigated the prevention of varices and a first variceal hemorrhage, the treatment of acute variceal hemorrhage, and prevention of recurrent variceal hemorrhage."
"We also examine special situations for which there is limited or no evidence."
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