title: Influence of variceal bleeding on natural history of ACLF and management options.
abstract: Patients with diagnosed and undiagnosed chronic liver diseases experience one or more acute assaults of a hepatic nature and develop a downhill course of liver diseases, a condition regarded as acute-on-chronic liver failure (ACLF). It is a medical emergency, the prognosis of ACLF is extremely bad and considerable numbers of patients with ACLF die even after diagnosis and receiving conservative treatment. ACLF is characterized by jaundice, coagulopathy, ascites and encephalopathy. ACLF patients are very sick and associated with different hemodynamic profiles and have very high 3-month mortality. As these groups of patients have high baseline hepatic venous pressure gradients, the chances of variceal bleed are also high, and the impact is also greater in comparison to stable cirrhosis; however, evidence is lacking to substantiate such effects. The aim of this review is to discuss the natural course of variceal bleeding in ACLF patients and to develop insights into the management of variceal bleeding in ACLF.
authors.affiliation: Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. shwapnil@agni.com.
authors.forename: Mamun
authors.initials: M
authors.lastname: Al-Mahtab
authors.affiliation: Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan.
authors.forename: Sheikh Mohammad Fazle
authors.initials: SM
authors.lastname: Akbar
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India.
authors.forename: Hitendra
authors.initials: H
authors.lastname: Garg
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000150:complications*; D018450:Disease Progression; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans
keywords: ACLF; Management; Natural history; Variceal bleed