Treatment of variceal bleeding in patients with cirrhosis of the liver

Gastroesophageal variceal bleeding is a complication of liver cirrhosis with a mortality rate of 20% at 6 weeks. Initial treatment includes blood volume restitution, antibiotic prophylaxis, and administration of vasoactive drugs to decrease portal pressure with the aim to arrest the bleeding and prevent rebleeding. Effective drugs include terlipressin and somatostatin, which should be started at admission and maintained for 2–5 days. Early endoscopic diagnosis (<12 hours) is mandatory. If variceal bleeding is confirmed endoscopic elastic band ligation (or injection sclerotherapy if banding is not possible) should be administered, but vasoactive drugs should not be withdrawn. Failures of combined medical therapy (drugs plus endoscopic therapy) should be evaluated for transjugular intrahepatic portosystemic shunt or portosystemic shunt surgery.