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Sarin SK, Kumar A, Angus PW, et al. Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations. Hepatol Int. 2011;5(2):607-24doi: 10.1007/s12072-010-9236-9.
Sarin, S. K., Kumar, A., Angus, P. W., Baijal, S. S., Baik, S. K., Bayraktar, Y., Chawla, Y. K., Choudhuri, G., Chung, J. W., de Franchis, R., de Silva, H. J., Garg, H., Garg, P. K., Helmy, A., Hou, M. C., Jafri, W., Jia, J. D., Lau, G. K., Li, C. Z., Lui, H. F., Maruyama, H., Pandey, C. M., Puri, A. S., Rerknimitr, R., Sahni, P., Saraya, A., Sharma, B. C., Sharma, P., Shiha, G., Sollano, J. D., Wu, J., Xu, R. Y., Yachha, S. K., Zhang, C. (2011). Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations. Hepatology international, 5(2), 607-24. https://doi.org/10.1007/s12072-010-9236-9
Sarin, Shiv Kumar, et al. "Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations." Hepatology international vol. 5,2 (2011): 607-24. doi: https://doi.org/10.1007/s12072-010-9236-9
Sarin SK, Kumar A, Angus PW, Baijal SS, Baik SK, Bayraktar Y, Chawla YK, Choudhuri G, Chung JW, de Franchis R, de Silva HJ, Garg H, Garg PK, Helmy A, Hou MC, Jafri W, Jia JD, Lau GK, Li CZ, Lui HF, Maruyama H, Pandey CM, Puri AS, Rerknimitr R, Sahni P, Saraya A, Sharma BC, Sharma P, Shiha G, Sollano JD, Wu J, Xu RY, Yachha SK, Zhang C. Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations. Hepatol Int. 2011 Jun;5(2):607-24. doi: 10.1007/s12072-010-9236-9. Epub 2011 Feb 19. PMID: 21484145; PMCID: PMC3090560.
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Hepatol Int. 2011 Jun;5(2):607-24. doi: 10.1007/s12072-010-9236-9. Epub 2011 Feb 19.

Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations.

Hepatology international

Shiv Kumar Sarin, Ashish Kumar, Peter W Angus, Sanjay Saran Baijal, Soon Koo Baik, Yusuf Bayraktar, Yogesh Kumar Chawla, Gourdas Choudhuri, Jin Wook Chung, Roberto de Franchis, H Janaka de Silva, Hitendra Garg, Pramod Kumar Garg, Ahmed Helmy, Ming-Chih Hou, Wasim Jafri, Ji-Dong Jia, George K Lau, Chang-Zheng Li, Hock Foong Lui, Hitoshi Maruyama, Chandra Mohan Pandey, Amrender S Puri, Rungsun Rerknimitr, Peush Sahni, Anoop Saraya, Barjesh Chander Sharma, Praveen Sharma, Gamal Shiha, Jose D Sollano, Justin Wu, Rui Yun Xu, Surender Kumar Yachha, Chunqing Zhang,

Affiliations

  1. Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India, [email protected].

PMID: 21484145 PMCID: PMC3090560 DOI: 10.1007/s12072-010-9236-9

Abstract

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.

References

  1. Hepatology. 2004 Oct;40(4):793-801 - PubMed
  2. Lancet. 1997 Nov 22;350(9090):1495-9 - PubMed
  3. Hepatology. 2004 Mar;39(3):746-53 - PubMed
  4. Hepatology. 1999 Jun;29(6):1655-61 - PubMed
  5. Lancet. 1999 Jan 9;353(9147):139-42 - PubMed
  6. J Hepatol. 2005 Jul;43(1):167-76 - PubMed
  7. Hepatology. 2001 May;33(5):1060-4 - PubMed
  8. Lancet. 1995 Sep 30;346(8979):865-8 - PubMed
  9. Crit Care Med. 1997 Jul;25(7):1125-32 - PubMed
  10. Hepatology. 1998 May;27(5):1207-12 - PubMed
  11. J Hepatol. 1996 Sep;25(3):390-4 - PubMed
  12. Hepatol Int. 2007 Sep;1(3):398-413 - PubMed
  13. Am J Gastroenterol. 2005 Mar;100(3):624-30 - PubMed
  14. Gastroenterology. 1986 May;90(5 Pt 1):1232-40 - PubMed
  15. Am J Gastroenterol. 2003 Jun;98(6):1391-4 - PubMed
  16. J Hepatol. 2000 Nov;33(5):846-52 - PubMed
  17. Gastroenterology. 2004 Oct;127(4):1123-30 - PubMed
  18. J Hepatol. 1992 May;15(1-2):256-61 - PubMed
  19. Gut. 2002 Aug;51(2):270-4 - PubMed
  20. Semin Liver Dis. 1999;19(4):475-505 - PubMed
  21. Endoscopy. 2007 Aug;39(8):679-85 - PubMed
  22. Gastroenterology. 2004 Apr;126(4):1175-89 - PubMed
  23. Gastroenterology. 1999 Sep;117(3):626-31 - PubMed
  24. Hepatology. 1989 Jun;9(6):808-14 - PubMed
  25. Hepatology. 2003 Sep;38(3):599-612 - PubMed
  26. Liver Int. 2006 Jun;26(5):512-9 - PubMed
  27. Hepatology. 2007 Sep;46(3):922-38 - PubMed
  28. Hepatology. 1999 Aug;30(2):384-9 - PubMed
  29. Hepatology. 2004 Jun;39(6):1623-30 - PubMed
  30. Hepatology. 2002 Mar;35(3):609-15 - PubMed
  31. Hepatol Int. 2008 Dec;2(4):429-39 - PubMed
  32. Am J Med. 1987 Aug;83(2):273-5 - PubMed
  33. Digestion. 1998 Jul;59 Suppl 2:54-7 - PubMed
  34. Gastrointest Endosc. 2003 Jul;58(1):122-7 - PubMed
  35. Gastroenterology. 1995 Jun;108(6):1828-34 - PubMed
  36. Gut. 1976 Jan;17(1):37-40 - PubMed
  37. Hepatol Int. 2008 Sep;2(3):322-34 - PubMed
  38. AJR Am J Roentgenol. 1977 Sep;129(3):514-6 - PubMed
  39. Gastroenterol Clin North Am. 2000 Jun;29(2):275-307, v - PubMed
  40. J Hepatol. 2008 Feb;48(2):229-36 - PubMed
  41. Cardiovasc Intervent Radiol. 2005 Mar-Apr;28(2):178-84 - PubMed
  42. Am J Gastroenterol. 2002 Apr;97(4):1010-5 - PubMed
  43. Hepatology. 2006 Apr;43(4):690-7 - PubMed
  44. Gastroenterology. 1991 May;100(5 Pt 1):1403-10 - PubMed
  45. AJR Am J Roentgenol. 2002 Feb;178(2):362-3 - PubMed
  46. J Hepatol. 2006 Oct;45(4):560-7 - PubMed
  47. Hepatology. 1992 Dec;16(6):1343-9 - PubMed
  48. Aliment Pharmacol Ther. 2003 Jan;17(1):53-64 - PubMed

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