Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2024; 16(2): 126-134
Published online Feb 27, 2024. doi: 10.4254/wjh.v16.i2.126
Contemporary concepts of prevention and management of gastroesophageal variceal bleeding in liver cirrhosis patients
Dmitry Victorovich Garbuzenko
Dmitry Victorovich Garbuzenko, Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk 454092, Russia
Author contributions: Garbuzenko DV contributed to the conception, design, acquisition, analysis, interpretation of data, wrote the manuscript and approved the final version.
Conflict-of-interest statement: Author have no conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dmitry Victorovich Garbuzenko, MD, PhD, Professor, Department of Faculty Surgery, South Ural State Medical University, 64 Vorovskogo Street, Chelyabinsk 454092, Russia. garb@inbox.ru
Received: November 30, 2023
Peer-review started: November 30, 2023
First decision: December 23, 2023
Revised: December 31, 2023
Accepted: January 29, 2024
Article in press: January 29, 2024
Published online: February 27, 2024
Processing time: 89 Days and 6.5 Hours
Abstract

This editorial describes the contemporary concepts of prevention and management of gastroesophageal variceal bleeding in liver cirrhosis (LC) patients according to the current guidelines. Gastroesophageal variceal bleeding is the most dangerous complication of portal hypertension in LC patients. Risk stratification and determination of an individual approach to the choice of therapeutic measures aimed at their prevention and management has emerged as one of the top concerns in modern hepatology. According to the current guidelines, in the absence of clinically significant portal hypertension, etiological and non-etiological therapies of LC is advisable for the primary preventing gastroesophageal variceal bleeding, whereas its presence serves as an indication for the administration of non-selective β-blockers, among which carvedilol is the drug of choice. Non-selective β-blockers, as well as endoscopic variceal ligation and transjugular intrahepatic portosystemic shunt can be used to prevent recurrence of gastroesophageal variceal bleeding. Pharmacotherapy with vasoactive drugs (terlipressin, somatostatin, octreotide), endoscopic variceal ligation, endovascular techniques and transjugular intrahepatic portosystemic shunt are recommended for the treatment of acute gastroesophageal variceal bleeding. Objective and accurate risk stratification of gastroesophageal variceal bleeding will allow developing individual strategies for their prevention and management, avoiding the first and further decompensation in LC, which will improve the prognosis and survival of patients suffering from it.

Keywords: Liver cirrhosis; Portal hypertension; Gastroesophageal variceal bleeding; Prevention; Management

Core Tip: Given that gastroesophageal variceal bleeding is the most dangerous complication of portal hypertension, objective and accurate risk stratification will allow developing individual strategies for their prevention and management, avoiding the first and further decompensation in liver cirrhosis, which will improve the prognosis and survival of patients suffering from it. This editorial describes the contemporary concepts of prevention and management of gastroesophageal variceal bleeding in liver cirrhosis patients according to the current guidelines.