5. Management of Complications of Portal Hypertension in Adults and Children: Variceal Hemorrhage

  1. E. Jenny Heathcote MB, BS, MD, FRCP, FRCP(C)4,5,6,7
  1. E. Jenny Heathcote MB, BS, MD, FRCP, FRCP(C)1,4,5,6,7,
  2. Simon Ling MB, ChB, MRCP2,5 and
  3. Binita M. Kamath MBBChir, MRCP, MTR3,5

Published Online: 4 SEP 2012

DOI: 10.1002/9781118314968.ch5

Hepatology: Diagnosis and Clinical Management

Hepatology: Diagnosis and Clinical Management

How to Cite

Heathcote, E. J., Ling, S. and Kamath, B. M. (2012) Management of Complications of Portal Hypertension in Adults and Children: Variceal Hemorrhage, in Hepatology: Diagnosis and Clinical Management (ed E. J. Heathcote), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118314968.ch5

Editor Information

  1. 4

    Francis Family Chair in Hepatology Research, Toronto, Ontario, Canada

  2. 5

    University of Toronto, Toronto, Ontario, Canada

  3. 6

    Patient Based Clinical Research Division, Toronto Western Research Institute, Toronto, Ontario, Canada

  4. 7

    University Health Network/Toronto Western Hospital, Toronto, Ontario, Canada

Author Information

  1. 1

    Division of Gastroenterology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada

  2. 2

    Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University Health Network, University of Toronto, Toronto, Ontario, Canada

  3. 3

    Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada

  4. 4

    Francis Family Chair in Hepatology Research, Toronto, Ontario, Canada

  5. 5

    University of Toronto, Toronto, Ontario, Canada

  6. 6

    Patient Based Clinical Research Division, Toronto Western Research Institute, Toronto, Ontario, Canada

  7. 7

    University Health Network/Toronto Western Hospital, Toronto, Ontario, Canada

Publication History

  1. Published Online: 4 SEP 2012
  2. Published Print: 12 OCT 2012

ISBN Information

Print ISBN: 9780470656174

Online ISBN: 9781118314968

SEARCH

Keywords:

  • variceal hemorrhage – prevention;
  • variceal hemorrhage – treatment

Summary

Guidelines recommend that all patients (adults) known to be cirrhotic should undergo screening endoscopy to check for varices. If present, long-term treatment with a non-selective beta-blocker significantly reduces the risk of subsequent variceal hemorrhage. Variceal hemorrhage is the second most common mode of death in any patient with cirrhosis, hence the need to identify all who have cirrhosis prior to this event. Due to the increase in blood volume during pregnancy all those with cirrhosis should undergo repeat screening during the second trimester. The relevant studies in children have not been conducted and there are no data on the benefit of beta-blockers in subjects with a portal vein thrombosis. Presentation with a presumed variceal hemorrhage should prompt urgent treatment in terms of resuscitation, i.v. vasoactive therapy, i.v. third-generation aphalosporin, and a proton pump inhibitor. Urgent upperpanendoscopy is required; if bleeding at the time of the procedure the patient should be intubated to prevent aspiration. Treatment of variceal hemorrhage is optimally treated with esophageal band ligation by an experienced endoscopist. If this is not available, arrangements should be made for safe transportation, once the patient is stable, to a center where such treatment is available. Occlusion tubes to compress any gastric and/or esophageal varices should be inserted prior to transport. In only a few select patients is surgical intervention required. A transjugular intrahepatic portosystemic shunt (TIPS) should only be performed in a tertiary referral center.