Pathophysiology and Management of Variceal Bleeding - PubMed (original) (raw)

Review

. 2021 Apr;81(6):647-667.

doi: 10.1007/s40265-021-01493-2. Epub 2021 Mar 12.

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Review

Pathophysiology and Management of Variceal Bleeding

Saleh A Alqahtani et al. Drugs. 2021 Apr.

Abstract

Cirrhosis is the fifth leading cause of death in adults. Advanced cirrhosis can cause significant portal hypertension (PH), which is responsible for many of the complications observed in patients with cirrhosis, such as varices. If portal pressure exceeds a certain threshold, the patient is at risk of developing life-threatening bleeding from varices. Variceal bleeding has a high incidence among patients with liver cirrhosis and carries a high risk of mortality and morbidity. The management of variceal bleeding is complex, often requiring a multidisciplinary approach involving pharmacological, endoscopic, and radiologic interventions. In terms of management, three stages can be considered: primary prophylaxis, active bleeding, and secondary prophylaxis. The main goal of primary and secondary prophylaxis is to prevent variceal bleeding. However, active variceal bleeding is a medical emergency that requires swift intervention to stop the bleeding and achieve durable hemostasis. We describe the pathophysiology of cirrhosis and PH to contextualize the formation of gastric and esophageal varices. We also discuss the currently available treatments and compare how they fare in each stage of clinical management, with a special focus on drugs that can prevent bleeding or assist in achieving hemostasis.

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References

    1. Bataller R, Brenner DA. Liver fibrosis. J Clin Investig. 2005;115(2):209–18. https://doi.org/10.1172/jci24282 . - DOI - PubMed
    1. Popper H, Uenfriend S. Hepatic fibrosis. Correlation of biochemical and morphologic investigations. Am J Med. 1970;49:707–21. https://doi.org/10.1016/s0002-9343(70)80135-8 . - DOI - PubMed
    1. Shackel NA, Patel K, McHutchison J. Chapter 50 - genomics in pathogenesis of cirrhosis. In: Ginsburg GS, Willard HF, editors. Essentials of genomic and personalized medicine. San Diego: Academic Press; 2010. p. 645–60. - DOI
    1. Collaborators GMaCoD. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England). 2015;385(9963):117-71. https://doi.org/10.1016/s0140-6736(14)61682-2 .
    1. Naveau S, Perlemuter G, Balian A. Epidemiology and natural history of cirrhosis. Rev Prat. 2005;55(14):1527–32. - PubMed

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