Gastroesophageal variceal bleeding occurs in 30 - 50% of patients of liver cirrhosis with portal hypertension, with 20-70% mortality in one year. Therefore, it is essential to screen these patients for varices and prevent first episode of bleeding by treating them with β-blockers or endoscopic variceal band ligation. Ideally, the patients with variceal bleeding should be treated in a unit where the personnel are familiar with the management of such patients and where routine therapeutic interventions can be undertaken. Proper management of such patients include: initial assessment, resuscitation, blood volume replacement, vasoactive agents, prevention of associated complications such as bacterial infections, hepatic encephalopathy, coagulopathy and thrombocytopenia, and specific therapy. Rebleeding occurs in about 60% patients within 2 years of their recovery from first variceal bleeding episode, with 33% mortality. Therefore, it is mandatory that all such patients must be started on combination of β-blockers and band ligation to prevent recurrence of bleeding. Patients who required shunt surgery/TIPSS to control the acute episode do not require further preventive measures. These clinical practice guidelines (CPGs) have been jointly developed by Pakistan Society of Hepatology (PSH) and Pakistan Society of Study of Liver Diseases (PSSLD).
JCPSP : Journal of the College of Physicians and Surgeons Pakistan
Farooqi, J. I.,
Shah, H. A.,
Khan, A. A.,
Khattak, A. K.,
Sher Rehman, S.,
Nawaz, A. A.,
Butt, J. A.,
Mirza, S. A.,
(2016). Clinical practice guidelines on the management of variceal bleeding. JCPSP : Journal of the College of Physicians and Surgeons Pakistan, 26(1), 63,e1-65,e18.
Available at: http://ecommons.aku.edu/pakistan_fhs_mc_med_med/195