[Gastrointestinal bleeding in portal hypertension in liver cirrhosis].
There are three major goals in the prophylaxis and treatment of upper gastrointestinal bleeding in portal hypertensive patients: prophylaxis of the first bleeding episode, therapy of active bleeding and prophylaxis of recurrent bleeding. Several therapeutic options are available: non-selective beta-blockers are the treatment of choice in the primary prophylaxis of the first bleeding episode in patients with large esophageal varices. Alternatively, endoscopic band ligation therapy is an option. Acute bleeding varices should be treated by ligation pharmacological and antibiotic therapy. Prophylaxis of recurrent bleeding is patient-dependent: shunt surgery is an option in young patients in a good medical condition (Child-Pugh class A). In patients with refractory ascites and a bilirubin below 3 mg/dl, TIPS is a good option together with recurrent bleeding. At the moment, there are no trials showing that endoscopic ligation therapy is superior to prevent pharmacological therapy. Nevertheless, the first-line treatment in most patients in Germany is endoscopic band ligation. Bleeding from ectopic varices and bleeding from hypertensive gastropathy should be treated individually either by endoscopy, TIPS or drug therapy.
Biecker
E
E
Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn.
Heller
J
J
Appenrodt
B
B
Schepke
M
M
Sauerbruch
T
T
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000818:Animals; D002986:Clinical Trials as Topic; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008103:Liver Cirrhosis / Q000150:complications / Q000628:therapy*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends; D055502:Secondary Prevention; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists