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[Gastrointestinal bleeding in portal hypertension in liver cirrhosis].
Z Gastroenterol. 2005 Jan; 43(1):35-46.ZG

Abstract

There are three major goals in the prophylaxis and treatment of upper gastrointestinal bleeding in portal hypertensive patients: prophylaxis of the first bleeding episode, therapy of active bleeding and prophylaxis of recurrent bleeding. Several therapeutic options are available: non-selective beta-blockers are the treatment of choice in the primary prophylaxis of the first bleeding episode in patients with large esophageal varices. Alternatively, endoscopic band ligation therapy is an option. Acute bleeding varices should be treated by ligation pharmacological and antibiotic therapy. Prophylaxis of recurrent bleeding is patient-dependent: shunt surgery is an option in young patients in a good medical condition (Child-Pugh class A). In patients with refractory ascites and a bilirubin below 3 mg/dl, TIPS is a good option together with recurrent bleeding. At the moment, there are no trials showing that endoscopic ligation therapy is superior to prevent pharmacological therapy. Nevertheless, the first-line treatment in most patients in Germany is endoscopic band ligation. Bleeding from ectopic varices and bleeding from hypertensive gastropathy should be treated individually either by endoscopy, TIPS or drug therapy.

Authors+Show Affiliations

Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article
Review

Language

ger

PubMed ID

15650970

Citation

Biecker, E, et al. "[Gastrointestinal Bleeding in Portal Hypertension in Liver Cirrhosis]." Zeitschrift Fur Gastroenterologie, vol. 43, no. 1, 2005, pp. 35-46.
Biecker E, Heller J, Appenrodt B, et al. [Gastrointestinal bleeding in portal hypertension in liver cirrhosis]. Z Gastroenterol. 2005;43(1):35-46.
Biecker, E., Heller, J., Appenrodt, B., Schepke, M., & Sauerbruch, T. (2005). [Gastrointestinal bleeding in portal hypertension in liver cirrhosis]. Zeitschrift Fur Gastroenterologie, 43(1), 35-46.
Biecker E, et al. [Gastrointestinal Bleeding in Portal Hypertension in Liver Cirrhosis]. Z Gastroenterol. 2005;43(1):35-46. PubMed PMID: 15650970.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Gastrointestinal bleeding in portal hypertension in liver cirrhosis]. AU - Biecker,E, AU - Heller,J, AU - Appenrodt,B, AU - Schepke,M, AU - Sauerbruch,T, PY - 2005/1/15/pubmed PY - 2005/3/25/medline PY - 2005/1/15/entrez SP - 35 EP - 46 JF - Zeitschrift fur Gastroenterologie JO - Z Gastroenterol VL - 43 IS - 1 N2 - There are three major goals in the prophylaxis and treatment of upper gastrointestinal bleeding in portal hypertensive patients: prophylaxis of the first bleeding episode, therapy of active bleeding and prophylaxis of recurrent bleeding. Several therapeutic options are available: non-selective beta-blockers are the treatment of choice in the primary prophylaxis of the first bleeding episode in patients with large esophageal varices. Alternatively, endoscopic band ligation therapy is an option. Acute bleeding varices should be treated by ligation pharmacological and antibiotic therapy. Prophylaxis of recurrent bleeding is patient-dependent: shunt surgery is an option in young patients in a good medical condition (Child-Pugh class A). In patients with refractory ascites and a bilirubin below 3 mg/dl, TIPS is a good option together with recurrent bleeding. At the moment, there are no trials showing that endoscopic ligation therapy is superior to prevent pharmacological therapy. Nevertheless, the first-line treatment in most patients in Germany is endoscopic band ligation. Bleeding from ectopic varices and bleeding from hypertensive gastropathy should be treated individually either by endoscopy, TIPS or drug therapy. SN - 0044-2771 UR - https://www.unboundmedicine.com/medline/citation/15650970/[Gastrointestinal_bleeding_in_portal_hypertension_in_liver_cirrhosis]_ L2 - https://www.thieme-connect.com/DOI/DOI?10.1055/s-2004-813909 DB - PRIME DP - Unbound Medicine ER -