Portal Hypertension and Bleeding Esophagogastric Varices (original) (raw)
Related papers
2014
Portal hypertension represent the major consequence of liver cirrhosis, with lifethreatening complications like upper digestive hemo rrhage through esophageal varices efraction. The physiopathology of portal hypertensi o in chronic liver disease is dominated by two factors, portal blood inflow and i ntrahepatic vascular resistance, which are responsible for the hemodinamic changes i n portal venous system. The main complication of portal hypertension is eso phageal and gastric varices development, and therefore the standard of care sho uld be focused primarly on prophylaxy and secondly, in advanced cases, on vari ce l bleeding treatment. We describe here the physiopathology of portal hype rtension in cirrhosis, as well as the current management of the most important and potentially catastrophic complication, acute variceal bleeding.
2006
Variceal bleeding is the most life-threating complication in liver cirrhosis. The aim of this study was to ascertain the risk factors of bleeding from esophageal varices.52 patients with liver cirrhosis and portal hypertension were included in prospective study. We analyzed the severity of liver dysfunction according to Child's classification, coagulation parameters, and endoscopic parameters: size, color, location of varices, and the presence of "red signs". Varices were classified as small, medium and large.Esophageal varices were found in 76.9% of the patients with liver cirrhosis and portal hypertension. Small varices were present in 10%, medium in 25% and large in 65% patients. 55% of them had variceal bleeding. Variceal bleeding was present in 50% patients with medium and in 65.38% patients with large varices. There was no bleeding in patients with small varices.Endoscopy revealed "red signs" before bleeding in 85% patients with large varices. There was a higher incidence of variceal bleeding in Child's group B. There were no significant differences (p>0.05) of the coagulation parameters in patients with and without variceal bleeding. Rebleeding was present in 86.36% patients. Most of them (52.63%) rebled between 7 weeks and 12 months after the first episode of variceal bleeding. In the patients with the most severe hepatocellular dysfunction (Child's group C) period between the first bleeding and rebleeding was the shortest (mean 20.8 days). Our study revealed association between the first bleeding and large varices and the "red signs". Coagulation disorders and hepatic dysfunction were not related to the initial episode of variceal bleeding. The risk of early rebleeding was higher in patients with severe hepatic dysfunction (Child's class C).
Pathophysiology of portal hypertension and esophageal varices
International journal of hepatology, 2012
Esophageal varices are the major complication of portal hypertension. It is detected in about 50% of cirrhosis patients, and approximately 5-15% of cirrhosis patients show newly formed varices or worsening of varices each year. The major therapeutic strategy of esophageal varices consists of primary prevention, treatment for bleeding varices, and secondary prevention, which are provided by pharmacological, endoscopic, interventional and surgical treatments. Optimal management of esophageal varices requires a clear understanding of the pathophysiology and natural history. In this paper, we outline the current knowledge and future prospect in the pathophysiology of esophageal varices and portal hypertension.
Portal pressure, presence of gastroesophageal varices and variceal bleeding
Hepatology, 1985
This study was performed to examine the relationships between portal pressure measurements and the presence of esophagogastric varices, the size of varices and the occurrence of hemorrhage from varices in 93 patients with alcoholic cirrhosis, using standardized measurements of portal pressure by hepatic vein catheterization.
Journal of Evolution of Medical and Dental Sciences, 2014
Approximately two thirds of patients with decompensated cirrhosis and one third of those with compensated cirrhosis have varices at the time of diagnosis. Therefore, it is essential to identify and treat those patients at highest risk because each episode of variceal hemorrhage carries a 20% to 30% risk of death, and 70% of patients not receiving treatment will die within 1 year of the initial bleeding episode. (1) METHODS: For this study, patients with cirrhosis with or without the evidence of any upper Gastrointestinal bleed, admitted in the department of medicine, JA Group of Hospitals, GR Medical College were taken. The study was conducted between September 2011 and November 2012 and cases were evaluated on the basis of clinical, haematological, ultrasonographic and endoscopic findings. Total number of cases were 100. RESULT: The prevalence of esophageal varices was 75% in cirrhotic patients out of which 28% had bleeding. The prevalence of gastric varices was 1.33%. The portal vein diameter correlated with the presence of varices while portal vein velocity, congestion index and liver vascular index had no significant correlation with esophageal varices. The Portal vein diameter more than 1.4 cm can predict varices with sensitivity 76 % (p<0.05) and Portal vein diameter more than 1.5 cm can detect bleeding varices in cirrhotic patients with sensitivity 55.56% and specificity 80.70%. CONCLUSION: This study showed that duration of illness, spleen size and tense ascitis on ultrasonography and portal vein diameter correlated with the presence of esophageal varices. The duration of illness and portal vein diameter are also correlated with bleeding manifestation
Managing liver cirrhotic complications: Overview of esophageal and gastric varices
Clinical and Molecular Hepatology
Managing liver cirrhosis in clinical practice is still a challenging problem as its progression is associated with serious complications, such as variceal bleeding that may increase mortality. Portal hypertension (PH) is the main key for the development of liver cirrhosis complications. Portal pressure above 10 mmHg, termed as clinically significant portal hypertension, is associated with formation of varices; meanwhile, portal pressure above 12 mmHg is associated with variceal bleeding. Hepatic vein pressure gradient measurement and esophagogastroduodenoscopy remain the gold standard for assessing portal pressure and detecting varices. Recently, non-invasive methods have been studied for evaluation of portal pressure and varices detection in liver cirrhotic patients. Various guidelines have been published for clinicians’ guidance in the management of esophagogastric varices which aims to prevent development of varices, acute variceal bleeding, and variceal rebleeding. This writing ...
All patients with liver cirrhosis and portal hypertension should be stratified by risk groups to individualize different therapeutic strategies to increase the effectiveness of treatment. In this regard, the development of primary prophylaxis of variceal bleeding and its management according to the severity of portal hypertension may be promising. This paper is to describe the modern principles of primary prophylaxis of esophageal variceal bleeding in patients with liver cirrhosis. The PubMed and EMbase databases, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews were used to search for relevant publications from 1999 to 2019. The results suggested that depending on the severity of portal hypertension, patients with cirrhosis should be divided into those who need preprimary prophylaxis, which aims to prevent the formation of esophageal varices, and those who require measures that aim to prevent esophageal variceal bleeding. In subclinical portal hypertension, therapy should be etiological and pathogenetic. Cirrhosis with clinically significant portal hypertension should receive nonselective β‐blockers if they have small esophageal varices and risk factors for variceal bleeding. Nonselective β‐blockers are the first‐line drugs for the primary prevention of bleeding from medium to large‐sized esophageal varices. Endoscopic band ligation is indicated for the patients who are intolerant to nonselective β‐blockers or in the case of contraindications to pharmacological therapy. In summary, the stratification of cirrhotic patients by the severity of portal hypertension and an individual approach to the choice of treatment may increase the effectiveness of therapy as well as improve survival rate of these patients.
Portal hypertension and variceal bleeding: An AASLD single topic symposium
Hepatology, 1998
Abbreviations: HVPG, hepatic venous pressure gradient; RCTs, randomized controlled trials; TIPS, transjugular intrahepatic portal systemic shunt; MA, meta-analysis; MAID, meta-analysis using individual data; CEA, carcinoembryonic antigen; GV, gastric varices; PHG, portal hypertensive gastropathy.