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Management of variceal haemorrhage.
Med J Malaysia. 1992 Dec; 47(4):238-47.MJ

Abstract

Variceal bleeding is the most important complication of portal hypertension. Mortality due to the first variceal bleeding is very high (50%) and of those surviving a variceal bleeding episode, up to 80% may rebleed. Proper management of the acute variceal bleeding episode, the prevention of rebleeding and primary prophylaxis for variceal haemorrhage are therefore mandatory in order to improve the morbidity and mortality of cirrhotic patients with variceal bleeding. Injection sclerotherapy would be the treatment of choice for acute variceal bleeding. Drug treatment in the form of either a combined vasopressin-nitroglycerin regimen or somatostatin may be used as an alternative. Patients not responding to these treatments should be referred for surgery. For the prevention of variceal rebleeding, non-selective beta-blockers should be tried first, reserving long-term injection sclerotherapy for patients with contraindications or intolerance to beta-blockers or in whom beta-blocker therapy has failed. Surgical rescue in the form of either shunt surgery or lever transplantation should be considered if either treatment fails. A new technique, transjugular intrahepatic portosystemic stent-shunt (TIPSS) may replace shunt surgery in the future. Beta-blockers is the treatment of choice for primary prophylaxis of variceal haemorrhage and has a role in preventing acute and chronic bleeding from congestive gastropathy. However, the above sequential approach from the least invasive to the more invasive therapeutic options may not be appropriate for all cirrhotic patients with variceal bleeding.

Authors+Show Affiliations

Hospital Besar, Kuala Lumpur.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

1363889

Citation

Merican, M I.. "Management of Variceal Haemorrhage." The Medical Journal of Malaysia, vol. 47, no. 4, 1992, pp. 238-47.
Merican MI. Management of variceal haemorrhage. Med J Malaysia. 1992;47(4):238-47.
Merican, M. I. (1992). Management of variceal haemorrhage. The Medical Journal of Malaysia, 47(4), 238-47.
Merican MI. Management of Variceal Haemorrhage. Med J Malaysia. 1992;47(4):238-47. PubMed PMID: 1363889.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of variceal haemorrhage. A1 - Merican,M I, PY - 1992/12/1/pubmed PY - 1992/12/1/medline PY - 1992/12/1/entrez SP - 238 EP - 47 JF - The Medical journal of Malaysia JO - Med J Malaysia VL - 47 IS - 4 N2 - Variceal bleeding is the most important complication of portal hypertension. Mortality due to the first variceal bleeding is very high (50%) and of those surviving a variceal bleeding episode, up to 80% may rebleed. Proper management of the acute variceal bleeding episode, the prevention of rebleeding and primary prophylaxis for variceal haemorrhage are therefore mandatory in order to improve the morbidity and mortality of cirrhotic patients with variceal bleeding. Injection sclerotherapy would be the treatment of choice for acute variceal bleeding. Drug treatment in the form of either a combined vasopressin-nitroglycerin regimen or somatostatin may be used as an alternative. Patients not responding to these treatments should be referred for surgery. For the prevention of variceal rebleeding, non-selective beta-blockers should be tried first, reserving long-term injection sclerotherapy for patients with contraindications or intolerance to beta-blockers or in whom beta-blocker therapy has failed. Surgical rescue in the form of either shunt surgery or lever transplantation should be considered if either treatment fails. A new technique, transjugular intrahepatic portosystemic stent-shunt (TIPSS) may replace shunt surgery in the future. Beta-blockers is the treatment of choice for primary prophylaxis of variceal haemorrhage and has a role in preventing acute and chronic bleeding from congestive gastropathy. However, the above sequential approach from the least invasive to the more invasive therapeutic options may not be appropriate for all cirrhotic patients with variceal bleeding. SN - 0300-5283 UR - https://www.unboundmedicine.com/medline/citation/1363889/Management_of_variceal_haemorrhage_ L2 - http://www.e-mjm.org/1992/v47n4/Variceal_Haemorrhage.pdf DB - PRIME DP - Unbound Medicine ER -