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[Digestive hemorrhage in cirrhosis]
1Service d'hépato-gastro-entérologie CHU, Angers.
La Revue Du Praticien
|March 1, 1997
Summary
Variceal bleeding in cirrhosis is a major cause of death. Treatments include endoscopic therapies, vasoactive drugs, and beta-blockers for prevention, with shunts considered if other methods fail.
Area of Science:
- Gastroenterology and Hepatology
- Clinical Medicine
- Internal Medicine
Context:
- Variceal bleeding represents a significant cause of mortality in patients with cirrhosis.
- Effective management is crucial for improving patient outcomes and survival rates.
Purpose:
- To outline current therapeutic strategies for managing acute variceal bleeding and preventing its recurrence in cirrhosis.
- To discuss the role of various pharmacological and endoscopic interventions.
Summary:
- First-line treatment for hemostasis involves endoscopic sclerotherapy or banding.
- Vasoactive drugs (terlipressin, somatostatin) serve as alternatives or adjuncts.
- Porto-systemic shunt is considered if endoscopic treatments fail.
- Primary prevention of variceal bleeding utilizes beta-blockers (propranolol, nadolol) or organic nitrates.
- Secondary prevention relies on endoscopic methods or beta-blockers.
Impact:
- Provides a concise overview of evidence-based guidelines for variceal bleeding management.
- Aids clinicians in selecting appropriate treatments for acute bleeding and long-term prevention.
- Highlights the importance of a multi-modal approach in managing this serious complication of cirrhosis.