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Gastrointestinal Bleeding pp 23–30Cite as

Management of Esophageal Variceal Bleeding

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Abstract

Esophageal variceal bleeding is a potentially life-threatening complication of portal hypertension. One-third of cirrhotic patients with documented varices bleed within 2 years from the time of initial diagnosis. Mortality rates from an initial episode of bleeding are 20–35% and approximately 30% with each additional episode of bleeding. Risk factors for acute bleeding episodes include advanced cirrhosis, large or proximal extension of varices, high portal pressure, continuation of alcohol consumption, and hepatocellular carcinoma.

Portal hypertension is characterized by the development of venous collaterals around areas of increased resistance, with resultant hemodynamic changes, including an increase in splanchnic flow and a hyperdynamic circulation. Increased resistance in the portal system commonly results from cirrhosis, but can also be secondary to acute hepatitis, congenital hepatic fibrosis, hepatic vein anomaly or obstruction, or hepatic vein thrombosis.

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Authors and Affiliations

  1. General Surgery Residency Training Program, Duke University Medical Center, Durham, NC, USA

    Keki Balsara M.D.

  2. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Lisa Pickett

Authors
  1. Keki Balsara M.D.
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  2. Lisa Pickett
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Corresponding author

Correspondence to Lisa Pickett .

Editor information

Editors and Affiliations

  1. Medical Center, Duke University, N. Duke St 3116, Durham , 27704, U.S.A.

    Aurora D. Pryor

  2. Medical Center, Duke University, N. Duke St 3116, Durham , 27704, U.S.A.

    Theodore N. Pappas

  3. Medical Center, Duke University, Durham, 27710, U.S.A.

    Malcolm Stanley Branch

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Balsara, K., Pickett, L. (2010). Management of Esophageal Variceal Bleeding. In: Pryor, A., Pappas, T., Branch, M. (eds) Gastrointestinal Bleeding. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1693-8_3

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  • DOI: https://doi.org/10.1007/978-1-4419-1693-8_3

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-1692-1

  • Online ISBN: 978-1-4419-1693-8

  • eBook Packages: MedicineMedicine (R0)

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