Systematic Reviews
Copyright ©The Author(s) 2016.
World J Hepatol. Feb 8, 2016; 8(4): 231-262
Published online Feb 8, 2016. doi: 10.4254/wjh.v8.i4.231
Table 12 Treatment of acute or chronic gastrointestinal bleeding from portal hypertensive gastropathy
Acute bleeding
Patient stabilization
Treat severe coagulopathy with highly elevated INR associated with cirrhosis with fresh frozen plasma
Treat severe thrombocytopenia associated with hypersplenism and bone marrow suppression from alcoholism with platelet transfusions
Transfuse packed erythrocytes to main hemoglobin level at about 8 g/dL
Consider antibiotic prophylaxis in patient with cirrhosis
Endoscopic therapy from bleeding-rarely used
Consider argon plasma coagulation
Hemospray - an experimental therapy
Octreotide - first line therapy
Vasopressin or terlipressin - second line therapy
Proton pump inhibitor therapy - adjunct therapy
Propranolol - can be instituted after bleeding controlled and patient stabilized
Interventional therapy
TIPS - for uncontrolled hemorrhage or for bleeding from PHG associated with variceal bleeding
Liver transplantation - for advanced end stage liver disease
Chronic bleeding
Treatment of anemia
Transfusions of packed erythrocytes as necessary
Iron replacement therapy
Consider propranolol