Recommendations on the Diagnosis and Initial Management of Acute Variceal Bleeding and Hepatorenal Syndrome in Patients with Cirrhosis

• Published in: Digestive diseases and sciences Vol. 64; no. 6; pp. 1419 - 1431
• Main Authors: Nevens, Frederik, Bittencourt, Paulo Lisboa, Coenraad, Minneke J., Ding, Huiguo, Hou, Ming-Chih, Laterre, Pierre-François, Mendizabal, Manuel, Ortiz-Olvera, Nayeli Xochiquetzal, Vorobioff, Julio D., Zhang, Wenhong, Angeli, Paolo
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-06-2019; Springer; Springer Nature B.V
• Subjects: Biochemistry; Care and treatment; Complications and side effects; Consensus; Digestive system; Early Diagnosis; Esophageal and Gastric Varices - diagnosis; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - therapy; Evidence-based medicine; Gastroenterology; Gastroenterology - standards; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - therapy; Hemorrhage; Hepatology; Hepatorenal Syndrome - diagnosis; Hepatorenal Syndrome - etiology; Hepatorenal Syndrome - therapy; Humans; Hypertension; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - diagnosis; Liver Cirrhosis - therapy; Medical diagnosis; Medicine; Medicine & Public Health; Oncology; Predictive Value of Tests; Prognosis; Review; Strategic planning (Business); Transplant Surgery; Treatment Outcome; Vasoactive drugs; Cirrhosis; Terlipressin; Acute variceal bleeding; Hepatorenal syndrome; Acute kidney injury
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-018-5448-y

Cirrhosis is a serious and life-threatening condition which imposes a significant socioeconomic burden on affected individuals and healthcare systems. Cirrhosis can result in portal hypertension, which may lead to major complications, including acute variceal bleeding and hepatorenal syndrome. Without prompt treatment, these complications may be life-threatening. Over the past 2 decades, new treatment modalities and treatment strategies have been introduced, which have improved patients’ prognosis, but the initial management of these severe complications continues to present a challenge. The present recommendations aim to increase clinicians’ knowledge on the importance of early diagnosis and treatment, and to provide evidence-based management strategies to potentially, further improve patient outcomes. Special attention was given to the role of terlipressin. A comprehensive non-systematic literature search was undertaken to evaluate the evidence for the diagnosis and initial management of acute variceal bleeding and hepatorenal syndrome in patients with cirrhosis. Recommendations on the diagnosis and initial management of acute variceal bleeding and hepatorenal syndrome in patients with cirrhosis have been developed based on the best available evidence and the expert opinion of the consensus panel following a comprehensive review of the available clinical data. Prompt identification and timely treatment of acute variceal bleeding and hepatorenal syndrome are essential to reduce the burden.