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Pathophysiology and Management of Variceal Bleeding

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Abstract

Cirrhosis is the fifth leading cause of death in adults. Advanced cirrhosis can cause significant portal hypertension (PH), which is responsible for many of the complications observed in patients with cirrhosis, such as varices. If portal pressure exceeds a certain threshold, the patient is at risk of develo** life-threatening bleeding from varices. Variceal bleeding has a high incidence among patients with liver cirrhosis and carries a high risk of mortality and morbidity. The management of variceal bleeding is complex, often requiring a multidisciplinary approach involving pharmacological, endoscopic, and radiologic interventions. In terms of management, three stages can be considered: primary prophylaxis, active bleeding, and secondary prophylaxis. The main goal of primary and secondary prophylaxis is to prevent variceal bleeding. However, active variceal bleeding is a medical emergency that requires swift intervention to stop the bleeding and achieve durable hemostasis. We describe the pathophysiology of cirrhosis and PH to contextualize the formation of gastric and esophageal varices. We also discuss the currently available treatments and compare how they fare in each stage of clinical management, with a special focus on drugs that can prevent bleeding or assist in achieving hemostasis.

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  1. Liver Transplant Unit, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia

    Saleh A. Alqahtani

  2. Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA

    Saleh A. Alqahtani

  3. Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, A3-269, Cleveland, OH, 44195, USA

    Sunguk Jang

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Alqahtani, S.A., Jang, S. Pathophysiology and Management of Variceal Bleeding. Drugs 81, 647–667 (2021). https://doi.org/10.1007/s40265-021-01493-2

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