TY - JOUR
T1 - Diagnosis and management of acute variceal bleeding
T2 - Asian Pacific Association for study of the Liver recommendations
AU - Sarin, Shiv Kumar
AU - Kumar, Ashish
AU - Angus, Peter W.
AU - Baijal, Sanjay Saran
AU - Baik, Soon Koo
AU - Bayraktar, Yusuf
AU - Chawla, Yogesh Kumar
AU - Choudhuri, Gourdas
AU - Chung, Jin Wook
AU - De Franchis, Roberto
AU - De Silva, H. Janaka
AU - Garg, Hitendra
AU - Garg, Pramod Kumar
AU - Helmy, Ahmed
AU - Hou, Ming Chih
AU - Jafri, Wasim
AU - Jia, Ji Dong
AU - Lau, George K.
AU - Li, Chang Zheng
AU - Lui, Hock Foong
AU - Maruyama, Hitoshi
AU - Pandey, Chandra Mohan
AU - Puri, Amrender S.
AU - Rerknimitr, Rungsun
AU - Sahni, Peush
AU - Saraya, Anoop
AU - Sharma, Barjesh Chander
AU - Sharma, Praveen
AU - Shiha, Gamal
AU - Sollano, Jose D.
AU - Wu, Justin
AU - Xu, Rui Yun
AU - Yachha, Surender Kumar
AU - Zhang, Chunqing
PY - 2011/6
Y1 - 2011/6
N2 - Background: Acute variceal bleeding (AVB) is a medical emergency and associated with a mortality of 20% at 6 weeks. Significant advances have occurred in the recent past and hence there is a need to update the existing consensus guidelines. There is also a need to include the literature from the Eastern and Asian countries where majority of patients with portal hypertension (PHT) live. Methods: The expert working party, predominantly from the Asia-Pacific region, reviewed the existing literature and deliberated to develop consensus guidelines. The working party adopted the Oxford system for developing an evidence-based approach. Only those statements that were unanimously approved by the experts were accepted. Results: AVB is defined as a bleed in a known or suspected case of PHT, with the presence of hematemesis within 24 h of presentation, and/or ongoing melena, with last melanic stool within last 24 h. The time frame for the AVB episode is 48 h. AVB is further classified as active or inactive at the time of endoscopy. Combination therapy with vasoactive drugs (<30 min of hospitalization) and endoscopic variceal ligation (door to scope time <6 h) is accepted as first-line therapy. Rebleeding (48 h of T 0) is further sub-classified as very early rebleeding (48 to 120 h from T 0), early rebleeding (6 to 42 days from T 0) and late rebleeding (after 42 days from T 0) to maintain uniformity in clinical trials. Emphasis should be to evaluate the role of adjusted blood requirement index (ABRI), assessment of associated comorbid conditions and poor predictors of non-response to combination therapy, and proposed APASL (Asian Pacific Association for Study of the Liver) Severity Score in assessing these patients. Role of hepatic venous pressure gradient in AVB is considered useful. Antibiotic (cephalosporins) prophylaxis is recommended and search for acute ischemic hepatic injury should be done. New guidelines have been developed for management of variceal bleed in patients with non-cirrhotic PHT and variceal bleed in pediatric patients. Conclusion: Management of acute variceal bleeding in Asia-Pacific region needs special attention for uniformity of treatment and future clinical trials.
AB - Background: Acute variceal bleeding (AVB) is a medical emergency and associated with a mortality of 20% at 6 weeks. Significant advances have occurred in the recent past and hence there is a need to update the existing consensus guidelines. There is also a need to include the literature from the Eastern and Asian countries where majority of patients with portal hypertension (PHT) live. Methods: The expert working party, predominantly from the Asia-Pacific region, reviewed the existing literature and deliberated to develop consensus guidelines. The working party adopted the Oxford system for developing an evidence-based approach. Only those statements that were unanimously approved by the experts were accepted. Results: AVB is defined as a bleed in a known or suspected case of PHT, with the presence of hematemesis within 24 h of presentation, and/or ongoing melena, with last melanic stool within last 24 h. The time frame for the AVB episode is 48 h. AVB is further classified as active or inactive at the time of endoscopy. Combination therapy with vasoactive drugs (<30 min of hospitalization) and endoscopic variceal ligation (door to scope time <6 h) is accepted as first-line therapy. Rebleeding (48 h of T 0) is further sub-classified as very early rebleeding (48 to 120 h from T 0), early rebleeding (6 to 42 days from T 0) and late rebleeding (after 42 days from T 0) to maintain uniformity in clinical trials. Emphasis should be to evaluate the role of adjusted blood requirement index (ABRI), assessment of associated comorbid conditions and poor predictors of non-response to combination therapy, and proposed APASL (Asian Pacific Association for Study of the Liver) Severity Score in assessing these patients. Role of hepatic venous pressure gradient in AVB is considered useful. Antibiotic (cephalosporins) prophylaxis is recommended and search for acute ischemic hepatic injury should be done. New guidelines have been developed for management of variceal bleed in patients with non-cirrhotic PHT and variceal bleed in pediatric patients. Conclusion: Management of acute variceal bleeding in Asia-Pacific region needs special attention for uniformity of treatment and future clinical trials.
UR - http://www.scopus.com/inward/record.url?scp=79956257594&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79956257594&partnerID=8YFLogxK
U2 - 10.1007/s12072-010-9236-9
DO - 10.1007/s12072-010-9236-9
M3 - Review article
C2 - 21484145
AN - SCOPUS:79956257594
SN - 1936-0533
VL - 5
SP - 607
EP - 624
JO - Hepatology International
JF - Hepatology International
IS - 2
ER -