%0 Journal Article
%T Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension
%A Erwin Biecker
%J ISRN Hepatology
%D 2013
%R 10.1155/2013/541836
%X Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology. 1. Introduction One of the main complications of liver cirrhosis is portal hypertension. Portal hypertension is defined as an hepatic venous pressure gradient (HVPG) above 5£¿mmHg. Clinical significant complications of portal hypertension like development of ascites and/or esophageal and gastric varices usually develop at an HVPG above 10£¿mmHg [1]. Bleeding from esophageal or gastric varices still carries a significant morbidity and mortality risk. The prevention of a first bleeding episode and the management of acute bleeding have markedly improved over the last years. This paper gives a concise overview of the current recommendations for the prevention and treatment of bleeding from esophageal, gastric, and ectopic varices as well as bleeding from portal hypertensive gastropathy. 2. Natural History of Esophageal Varices At the first diagnosis, about 30 to 40% of patients with compensated cirrhosis of the liver and 60% of patients with ascites present with esophageal varices. The annual incidence for the development of new varices in patients who were diagnosed with liver cirrhosis without varices is between 5 and 10% [2¨C5]. Once varices have developed, they have
%U http://www.hindawi.com/journals/isrn.hepatology/2013/541836/