VARICEAL BLEEDING: UPDATE OF RECOMMENDATIONS FROM THE BRAZILIAN ASSOCIATION OF HEPATOLOGY

BITTENCOURT, Paulo Lisboa; STRAUSS, Edna; FARIAS, Alberto Queiroz; MATTOS, Angelo Alves de; LOPES, Edmundo Pessoa

doi:10.1590/S0004-2803.201700000-79

Brasil

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Consensus • Arq. Gastroenterol. 54 (04) • 2017 • https://doi.org/10.1590/S0004-2803.201700000-79 linkcopy

VARICEAL BLEEDING: UPDATE OF RECOMMENDATIONS FROM THE BRAZILIAN ASSOCIATION OF HEPATOLOGY

Sangramento varicoso: atualização das recomendações da Sociedade Brasileira de Hepatologia

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Since the publication of the Brazilian Association of Hepatology recommendations for the prevention and treatment of variceal bleeding in 2010, new evidence-based data were reported in the literature. This has changed our current management for portal hypertension. This review updates the previous recommendations. It takes the new prognostic staging of cirrhosis into account allowing tailored treatment for advanced fibrosis, compensated or decompensated cirrhosis. An organizing panel of five experts reviewed all recommendations according to available data, which were subsequently scrutinized by all members of the Brazilian Association of Hepatology using a web-based approach. The accepted recommendations are presented in this manuscript.

HEADINGS: Gastrointestinal hemorrhage; Esophageal and gastric varices; Liver cirrhosis; Infection

Stage	Advanced fibrosis or compensated cirrhosis
Stage	1	2	3	4	5
HVPG	>5 mmHg	≥10 mmHg	>12 mmHg	12-20 mmHg	>20 mmHg
Varices	No varices	Varices	Variceal bleeding		Any
Clinical events	Mild PH	CSPH	No other events	Other non-bleeding events (ascites/HE)	2nd event

Mortality (5 year)	1.5%	10%	20%	30%	88%

Progression (5 year)	21% to stage 2	8% to stage 3	45% to stage 5	48% to stage 5
	1.5% to stage 3 or 4	20% to stage 4

Aims of therapy	Prevention of	Prevention of	Control of bleeding	Prevention of other clinical events and death
	decompensation	decompensation	Prevention of	Assessment for liver transplantation
		and variceal bleeding	rebleeding and death

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[TFN1] PH: portal hypertension; HVPG: hepatic vein pressure gradient; CSPH: clinical significant PH; HE: hepatic encephalopathy. Adapted from references 7, 10 and 15.