GASTROENTEROLOGY ARTICLE OF THE WEEK
April 8, 2010
Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med 2010;362;823-32.
1. The strongest predictor for the development of varices is
a) the etiology of cirrhosis
b) the hepatic vein portal gradient
c) the Child’s Pugh Class
d) the MELD score
2. The 1-yr risk of bleeding from large esophageal varices identified on screening endoscopy is :
a) 50%
b) 70%
c) 5%
d) 15%
True of False
3. After achieving variceal obliteration with banding, follow up endoscopy should be performed in 1-3 months and then every 6-12 months indefinitely.
4. Recombinant factor VII infusion can be used as a bridge to TIPS in decompensated patients with persistent bleeding.
5. After an episode of acute variceal bleeding, combination pharmacologic and endoscopic therapy is recommended to decrease risk of recurrence.
6. Patients with cirrhosis but no varices can benefit from non-selective beta-blockers to delay development of varices.
7. Once a patient is placed on beta blockers as the intervention to decrease risk of bleeding from medium sized varices, follow up surveillance endoscopy is no longer needed.
8. The prevalence of portal hypertensive gastropathy is the same whether the patient has undergone variceal ligation or not.
9. A second IV bolus of octreotide can be used of variceal hemorrhage persists after the initial bolus and initiation of continuous infusion
10. The rebleeding rate is lowest if the HVPG is reduced to <12 mmHg and/or reduced by >20% from baseline after therapeutic intervention.