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2013 ; 2013
(ä): 541836
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Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension
#MMPMID27335828
Biecker E
ISRN Hepatol
2013[]; 2013
(ä): 541836
PMID27335828
show ga
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.