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

Show simple item record Sarin, S.K. en_US Kumar, A. en_US Angus, P.W. en_US Baijal, S.S. en_US Baik, S.K. en_US Bayraktar, Y. en_US Chawla, Y.K. en_US Choudhuri, G. en_US Chung, J.W. en_US de Franchis, R. en_US de Silva, H.J. en_US Garg, H. en_US Garg, P.K. en_US Helmy, A. en_US Hou, M.C. en_US Jafri, W. en_US Jia, J.D. en_US Lau, G.K. en_US Li, C.Z. en_US Lui, H.F. en_US Maruyama, H. en_US Pandey, C.M. en_US Puri, A.S. en_US Rerknimitr, R. en_US Sahni, P. en_US Saraya, A. en_US Sharma, B.C. en_US Sharma, P. en_US Shiha, G. en_US Sollano, J.D. en_US Wu, J. en_US Xu, R.Y. en_US Yachha, S.K. en_US Zhang, C. en_US Asian Pacific Association for the Study of the Liver (APASL) Working Party on Portal Hypertension. 2014-10-29T09:32:36Z 2014-10-29T09:32:36Z 2011 en_US
dc.identifier.citation Hepatology International ; 5(2): 607-24. en_US
dc.identifier.issn 1936-0533 (Print) en_US
dc.identifier.issn 1936-0541 (Electronic) en_US
dc.description Indexed in Scopus; In PUBMED
dc.description.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.
dc.publisher Springer International en_US
dc.title Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations en_US
dc.type Article en_US
dc.identifier.department Medicine en_US
dc.creator.corporateauthor Asian Pacific Association for the Study of the Liver en_US
dc.description.note Indexed in MEDLINE en_US

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