Management of variceal haemorrhage

Oesophageal varices are a very severe complication of portal hypertension which is mainly caused by hepatic cirrhosis. Variceal bleeding often has a dramatic course, may recur and is associated with substantial mortality. Thanks to the currently used methods of treatment, in the last two decades the mortality rate due to bleeding has decreased by half, from 40 to 20%. This was possible owing to better understanding of the mechanisms that cause an increase in portal hypertension, and thanks to improvement in pharmacological, endoscopic and radiological treatments. The modern management of oesophageal variceal bleeding should take into consideration the place of treatment – the intensive care unit, cautious haemodynamic stabilization, effective treatment of infection and administration of drugs reducing portal pressure. Endoscopic therapy plays a fundamental role, with variceal band ligation being the treatment of choice and injection sclerotherapy as an alternative option. Very important are rebleeding prevention and primary bleeding prophylaxis. When endoscopic and pharmacological treatments fail, transjugular porto-systemic shunt (TIPS) is an alternative both for the treatment of acute bleeding and as secondary prophylaxis.