Abstract
One of the most common and life-threatening complications of portal hypertension is gastrointestinal bleeding secondary to oesophageal varices (OV). Estimates of the annual bleeding risk range from 10%-30% [1,2]. Despite advances in management, mortality remains high; 6-week mortality is around 15%, especially in patients with advanced liver dysfunction. Management is also resource and cost intensive, often requiring intensive care or high dependency unit admission, blood transfusion, vasoconstrictor therapy, endoscopic treatment and antibiotic prophylaxis [1,3].
Highlights
One of the most common and life-threatening complications of portal hypertension is gastrointestinal bleeding secondary to oesophageal varices (OV)
There was no significant difference in the rate of first bleeding episode (7% vs. 11%) or in mortality (8% vs. 15%) but the probability of recurrence of OV was lower in the group which received combined prophylaxis (19% vs. 33%, p=0.03)
There are no conclusive data to recommend the use of combined primary prophylaxis, with Non-selective beta-blockers (NSBB) plus endoscopic band ligation (EBL), to prevent first episode of variceal bleeding and only a few small trials have been conducted comparing monotherapy with combined therapy
Summary
One of the most common and life-threatening complications of portal hypertension is gastrointestinal bleeding secondary to oesophageal varices (OV). The latest Baveno VI Consensus recommend that patients with compensated cirrhosis with liver stiffness 150,000 have a very low risk of varices requiring treatment and can avoid screening OGD. They recommend that if liver stiffness increases or platelet count declines, these patients should undergo screening OGD [5]. Those patients with compensated cirrhosis but with radiological signs of portal hypertension, such as radiological ascites, splenomegaly, collateral circulation, portal vein dilatation or biphasic or reverse portal flow should undergo screening OGD as well
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