In patients with cirrhosis and portal hypertension, gastrointestinal haemorrhage is a major complication and cause of death. Oesophageal varices are present in approximately 50% of patients with cirrhosis. Among patients with varices, the risk of gastrointestinal haemorrhage ranges from 30% to 50% and half of these patients die within 6 weeks after bleeding.
Normal care includes (in addition to resuscitation) airway management, routine antibiotics, early endoscopy along with pharmacotherapy with either vasopressin or octreotide (or related compounds). Glypressin is now the widely used drug. Vasopressin and glypressin reduce portal pressure by splanchnic arteriolar vasoconstriction, whereas somatostatin and octreotide lower portal pressure by decreasing hepatic blood flow.
Temporary tamponade can be achieved with a Sengstaken-Blackmore tube. It should be considered as a salvage procedure. Tamponade is 90% successful at stopping haemorrhage. Unfortunately 50% patients re-bleed within 24 hours of removal of tamponade. Prednisolone has a role, after careful consideration, in patients with alcoholic hepatitis but not in the acute management of variceal haemorrhage.
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