13 research outputs found
Dynamics of sustained use and abandonment of clean cooking systems: study protocol for community-based system dynamics modeling
Co-catalyst free Titanate Nanorods for improved Hydrogen production under solar light irradiation
Anticorrosion Potential of Flectofenine on Mild Steel in Hydrochloric Acid Media: Experimental and Theoretical Study
A systematic approach for design of rainwater harvesting system and groundwater aquifer modeling
Impact of prenatal technologies on the sex ratio in India: an overview
Genetics of disease, diagnosis and treatmen
Smart control of nonlinear vibrations of doubly curved functionally graded laminated composite shells under a thermal environment using 1–3 piezoelectric composites
Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations
Acute variceal bleeding (AVB) is a medical emergency and associated with a mortality of 20% at 6 weeks. Significant advances have occurred in the recent past and hence there is a need to update the existing consensus guidelines. There is also a need to include the literature from the Eastern and Asian countries where majority of patients with portal hypertension (PHT) live.
The expert working party, predominantly from the Asia-Pacific region, reviewed the existing literature and deliberated to develop consensus guidelines. The working party adopted the Oxford system for developing an evidence-based approach. Only those statements that were unanimously approved by the experts were accepted.
AVB is defined as a bleed in a known or suspected case of PHT, with the presence of hematemesis within 24 h of presentation, and/or ongoing melena, with last melanic stool within last 24 h. The time frame for the AVB episode is 48 h. AVB is further classified as active or inactive at the time of endoscopy. Combination therapy with vasoactive drugs (< 30 min of hospitalization) and endoscopic variceal ligation (door to scope time < 6 h) is accepted as first-line therapy. Rebleeding (48 h of T (0)) is further sub-classified as very early rebleeding (48 to 120 h from T (0)), early rebleeding (6 to 42 days from T (0)) and late rebleeding (after 42 days from T (0)) to maintain uniformity in clinical trials. Emphasis should be to evaluate the role of adjusted blood requirement index (ABRI), assessment of associated comorbid conditions and poor predictors of non-response to combination therapy, and proposed APASL (Asian Pacific Association for Study of the Liver) Severity Score in assessing these patients. Role of hepatic venous pressure gradient in AVB is considered useful. Antibiotic (cephalosporins) prophylaxis is recommended and search for acute ischemic hepatic injury should be done. New guidelines have been developed for management of variceal bleed in patients with non-cirrhotic PHT and variceal bleed in pediatric patients.
Management of acute variceal bleeding in Asia-Pacific region needs special attention for uniformity of treatment and future clinical trials