title: Management of gastroesophageal varices in cirrhotic patients: current status and future directions.
abstract: Bleeding from gastroesophageal varices (GEV) is a serious event in cirrhotic patients and can cause death. According to the explosion theory, progressive portal hypertension is the primary mechanism underlying variceal bleeding. There are two approaches for treating GEV: primary prophylaxis to manage bleeding or emergency treatment for bleeding followed by secondary prophylaxis. Treatment methods can be classified into two categories: 1) Those used to decrease portal pressure, such as medication (i.e., nonselective β-blockers), radiological intervention [transjugular intrahepatic portosystemic shunt (TIPS)] or a surgical approach (i.e., portacaval shunt), and 2) Those used to obstruct GEV, such as endoscopy [endoscopic variceal ligation (EVL), endoscopic injection sclerotherapy (EIS), and tissue adhesive injection] or radiological intervention [balloon-occluded retrograde transvenous obliteration (BRTO)]. Clinicians should choose a treatment method based on an understanding of its efficacy and limitations. Furthermore, elastography techniques and serum biomarkers are noninvasive methods for estimating portal pressure and may be helpful in managing GEV. The impact of these advances in cirrhosis therapy should be evaluated for their effectiveness in treating GEV.
authors.affiliation: Department of Hepatology, Kanazawa Medical University, Uchinada-machi, Ishikawa, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Toshikuni
authors.affiliation: Department of Internal Medicine, Hiroshima City Hospital, Naka-Ku, Hiroshima, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Takuma
authors.affiliation: Department of Hepatology, Kanazawa Medical University, Uchinada-machi, Ishikawa, Japan.
authors.forename: Mikihiro
authors.initials: M
authors.lastname: Tsutsumi
mesh_terms: D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques / Q000009:adverse effects; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents