Complications, management and prevention of variceal hemorrhage

Abstract

Bleeding from esophageal varices (EV) is an acute clinical problem with manifestations of haematemesis, with or without melaena or hematochezia, which is accompanied by hemodynamic instability. It is the main complication of portal hypertension due to cirrhosis. It represents 10-30% of all cases of upper gastrointestinal bleeding. Esophageal varices occur in 30% of patients with cirrhosis and are responsible for 80-90% of bleeding. They are the result of portal hypertension, which is described as portal vein pressure exceeding 10 mmHg; when it exceeds 12 mmHg, it is associated with a high risk of bleeding. Its endoscopic severity is correlated with the hepatic venous pressure gradient (HVPG) and consequently with the risk of variceal hemorrhage.