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[Non-surgical treatment of hemorrhage caused by portal hypertension in cirrhosis: hemostatic treatment, prevention of the first hemorrhage, prevention of recurrence].
Rev Prat. 1990 Jun 01; 40(16):1458-61.RP

Abstract

Oesophageal varices are found in two-thirds of cirrhotic patients, and they bleed by rupture in only 50% of the cases. Each bleeding episode carries a mortality risk of about 30%. Recurrences occur in 70% of survivors. Patients with cirrhosis may be considered as being at risk of haemorrhage when large varices, notably with "red signs", are discovered at endoscopy. In two-thirds of the cases, the hemorrhage from ruptured oesophageal varices has stopped by the time emergency endoscopy is performed, but its severity mainly depends on its early recurrence. Haemostatic treatments are justified only in the presence of an active haemorrhage. The best method seems to be endoscopic variceal sclerotherapy carried out in a specialized centre by a centre by a trained endoscopist. The other methods should be used only when sclerotherapy has failed. The prevention of recurrences (secondary prophylaxis) mainly rests on the eradication of varices by endoscopic sclerosis. The addition of propranolol to treatment is probably useful. The seriousness of haemorrhages due to rupture of oesophageal varices justifies primary prophylaxis in patients with large varices found at endoscopy. At present, nonselective beta-blockers constitute the best method of primary prophylaxis. In about 1 out of 5 cases, haemorrhages in cirrhotic patients are due to a different lesion, such as ruptured gastric varices or gastric disease due to portal hypertension. The treatment of haemorrhages causes by these lesions has not been clearly defined, but surgical haemostasis is sometimes indicated in case of ruptures gastric varices.

Authors+Show Affiliations

Pascal JP
Service d'hépato-gastroentérologie, CHU Purpan, Toulouse.

MeSH

Esophageal and Gastric VaricesGastrointestinal HemorrhageHemostatic TechniquesHumansHypertension, PortalLiver CirrhosisRecurrence

Pub Type(s)

English Abstract
Journal Article

Language

fre

PubMed ID

2193366

Citation

Pascal, J P.. "[Non-surgical Treatment of Hemorrhage Caused By Portal Hypertension in Cirrhosis: Hemostatic Treatment, Prevention of the First Hemorrhage, Prevention of Recurrence]." La Revue Du Praticien, vol. 40, no. 16, 1990, pp. 1458-61.
Pascal JP. [Non-surgical treatment of hemorrhage caused by portal hypertension in cirrhosis: hemostatic treatment, prevention of the first hemorrhage, prevention of recurrence]. Rev Prat. 1990;40(16):1458-61.
Pascal, J. P. (1990). [Non-surgical treatment of hemorrhage caused by portal hypertension in cirrhosis: hemostatic treatment, prevention of the first hemorrhage, prevention of recurrence]. La Revue Du Praticien, 40(16), 1458-61.
Pascal JP. [Non-surgical Treatment of Hemorrhage Caused By Portal Hypertension in Cirrhosis: Hemostatic Treatment, Prevention of the First Hemorrhage, Prevention of Recurrence]. Rev Prat. 1990 Jun 1;40(16):1458-61. PubMed PMID: 2193366.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Non-surgical treatment of hemorrhage caused by portal hypertension in cirrhosis: hemostatic treatment, prevention of the first hemorrhage, prevention of recurrence]. A1 - Pascal,J P, PY - 1990/6/1/pubmed PY - 1990/6/1/medline PY - 1990/6/1/entrez SP - 1458 EP - 61 JF - La Revue du praticien JO - Rev Prat VL - 40 IS - 16 N2 - Oesophageal varices are found in two-thirds of cirrhotic patients, and they bleed by rupture in only 50% of the cases. Each bleeding episode carries a mortality risk of about 30%. Recurrences occur in 70% of survivors. Patients with cirrhosis may be considered as being at risk of haemorrhage when large varices, notably with "red signs", are discovered at endoscopy. In two-thirds of the cases, the hemorrhage from ruptured oesophageal varices has stopped by the time emergency endoscopy is performed, but its severity mainly depends on its early recurrence. Haemostatic treatments are justified only in the presence of an active haemorrhage. The best method seems to be endoscopic variceal sclerotherapy carried out in a specialized centre by a centre by a trained endoscopist. The other methods should be used only when sclerotherapy has failed. The prevention of recurrences (secondary prophylaxis) mainly rests on the eradication of varices by endoscopic sclerosis. The addition of propranolol to treatment is probably useful. The seriousness of haemorrhages due to rupture of oesophageal varices justifies primary prophylaxis in patients with large varices found at endoscopy. At present, nonselective beta-blockers constitute the best method of primary prophylaxis. In about 1 out of 5 cases, haemorrhages in cirrhotic patients are due to a different lesion, such as ruptured gastric varices or gastric disease due to portal hypertension. The treatment of haemorrhages causes by these lesions has not been clearly defined, but surgical haemostasis is sometimes indicated in case of ruptures gastric varices. SN - 0035-2640 UR - https://www.unboundmedicine.com/medline/citation/2193366/[Non_surgical_treatment_of_hemorrhage_caused_by_portal_hypertension_in_cirrhosis:_hemostatic_treatment_prevention_of_the_first_hemorrhage_prevention_of_recurrence]_ DB - PRIME DP - Unbound Medicine ER -