Bleeding caused by portal hypertension

Atif Zaman, Naga Chalasani

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Variceal bleeding is one of the dreaded complications of portal hypertension. Patients who have suspected or proven cirrhosis should undergo diagnostic upper endoscopy to detect medium and large gastro-esophageal varices. Patients with medium and large gastro-esophageal varices should be treated with nonselective beta-blockers (propranolol or nadolol), and these agents should be titrated to a heart rate of 55 beats per minute or adverse effects. If there are contraindications to or if patients are intolerant to beta-blockers, it is appropriate to consider prophylactic banding therapy for individuals with medium-to-large esophageal varices. When patients who have cirrhosis present with GI bleeding, they should be resuscitated and receive octreotide or other vasoactive agents. Endoscopy should be performed promptly to diagnose the source of bleeding and to provide endoscopic therapy (preferably banding). The currently available treatment for acute variceal bleeding provides hemostasis in most patients. These patients, however, are at significant risk for rebleeding unless secondary prophylaxis is provided. Although various pharmacological, endoscopic, radiological, and surgical options are available, combined pharmacological and endoscopic therapy is the most common form of secondary prophylaxis. TIPS is a radiologically placed portasystemic shunt, and if placed in suitable patients, it can provide effective treatment for patients with variceal bleeding that is refractory to medical and endoscopic therapy.

Original languageEnglish
Pages (from-to)623-642
Number of pages20
JournalGastroenterology Clinics of North America
Volume34
Issue number4
DOIs
StatePublished - Dec 2005

Fingerprint

Portal Hypertension
Hemorrhage
Esophageal and Gastric Varices
Endoscopy
Fibrosis
Therapeutics
Nadolol
Pharmacology
Surgical Portasystemic Shunt
Octreotide
Hemostasis
Propranolol
Heart Rate

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Bleeding caused by portal hypertension. / Zaman, Atif; Chalasani, Naga.

In: Gastroenterology Clinics of North America, Vol. 34, No. 4, 12.2005, p. 623-642.

Research output: Contribution to journalArticle

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