Treatment of bleeding caused by liver cirrhosis-associated portal hypertension – update of Czech Society of Hepatology guidelines

Czech version

Authors: T. Fejfar ¹; T. Vaňásek ¹; R. Brůha ²; P. Hůlek ^1,3; V. Procházka ⁴; J. Petrtýl ²; J. Lata ³
Authors‘ workplace: II. interní gastroenterologická klinika LF UK a FN Hradec Králové ¹; IV. interní klinika – klinika gastroenterologie a hepatologie 1. LF UK a VFN v Praze ²; Katedra interní oborů, LF OU v Ostravě ³; II. interní klinika – gastroenterologická a hepatologická LF UP a FN Olomouc ⁴
Published in: Gastroent Hepatol 2017; 71(2): 105-116
Category: Hepatology: Best Practises
doi: https://doi.org/10.14735/amgh2017105

Varikózní krvácení je nejzávažnější a potenciálně smrtící komplikací portální hypertenze. Adekvátní léčebný postup sestává ze zajištění nemocného volumexpanzí a hemosubstitucí, antibiotické profylaxe a zejména z podávání vazoaktivní léčby spolu s endoskopickým ošetřením. V případě selhání je indikována transjugulární intrahepatální portosystémová spojka. Jako most k transjugulární intrahepatální portosystémové spojce či v případě její kontraindikace se zavádí dedikovaný jícnový stent (Danis) nebo balonková sonda. V primární a sekundární profylaxi se uplatňuje léčba neselektivním β-blokátorem a endoskopická léčba. Následující článek přináší aktualizaci doporučení České hepatologické společnosti pro tuto léčbu.

Overview

Variceal bleeding is one of the severest life threatening complications of portal hypertension. Appropriate treatment includes initial general management, fluid replacement and hemo-substitution, antibiotic prophylaxis, vasoactive medication, and endoscopic treatments. A transjugular intrahepatic portosystemic shunt (TIPS) is indicated in cases of failure. A dedicated esophageal metal stent or balloon tamponade is sometimes used as a “bridge” to TIPS placement or in cases of TIPS contraindications. Non-selective β-blockers and endoscopic therapy are used in primary and secondary prophylaxis. The following paper summarises the update to the recommendation of the Czech Society of Hepatology for this treatment.

Key words:
portal hypertension – bleeding – treatment

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

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