Issue 4/2023
Koemdzhiev, D., P. Karagyozov, P.
Gastroenterology Clinic, Acibadem City Clinic Tokuda Hospital – Sofia
Advanced cirrhosis can cause significant portal hypertension (PH), which is responsible for many of the complications observed in these patients, such as varices. Gastrointestinal bleeding is one of the most relevant causes of death in patients with cirrhosis and clinically significant portal hypertension, with gastroesophageal varices being the most frequent source of hemorrhage. Active variceal bleeding is a medical emergency that requires swift intervention to stop the bleeding and achieve durable hemostasis. The mortality rate in acute variceal haemorrhage remains high (around 15%). Despite survival has improved thanks to the standardization on medical treatment aiming to decrease portal hypertension and prevent infections, mortality remains significant. Effective resuscitation (haemostasis, volume management) is essential to prevent complications. Endoscopic treatment is initially performed to stop variceal hemorrhage. Treatment is based on the combined use of vasoactive drugs, endoscopic therapy, radiologic intervention and prophylactic antibiotics. Endoscopic therapy and radiologic intervention for gastroesophageal bleeding have rapidly developed in the recent decades. Treatment failure is best managed by transjugular intrahepatic portosystemic shunt (TIPS).
Key words: cirrhosis; varices; bleeding; endoscopy;
Address for correspodnce:
Koemdzhiev, D.
Clinic of Gastroenterology, floor 7,
Acibadem City Clinic UMBAL „Tokuda“
51B, „Nikola Y. Vaptsarov“ , Blvd.
1407, Sofia
e-mail: dimitar.koemdzhiev@yahoo.bg