Treatment of Chronic Liver Failure in Decompensated Cirrhosis with Portal Hypertensive Gastropathy and Chronic Haemorrhage
Clinical Scenario
This protocol applies to patients with chronic liver failure arising in the context of decompensated liver cirrhosis complicated by portal hypertensive gastropathy (PHG). Ongoing chronic mucosal haemorrhage leads to iron-deficiency anaemia, and in a subset of patients the blood loss becomes transfusion-dependent.
Condition in Focus — Liver Cirrhosis (Decompensated)
Portal hypertension in decompensated cirrhosis produces gastropathic changes in the gastric mucosa, resulting in persistent low-grade bleeding. First-line therapy for chronic haemorrhage from PHG is non-selective beta-blocker (NSBB) therapy, combined with iron supplementation and blood transfusion when clinically indicated. A proportion of patients, however, fail to respond to or cannot tolerate this approach, leaving them with ongoing transfusion requirements.
Next-Step Management — Partial Overview
For patients with transfusion-dependent PHG-related haemorrhage in whom initial pharmacological management is not effective or is not tolerated, the structured protocol describes an interventional procedure that may be considered in appropriately selected patients without contraindications. The complete eligibility criteria, procedural details, and decision algorithm are available via the full protocol.
References
DOI: 10.1016/j.jhep.2018.03.024
- First-line therapy for chronic haemorrhage from PHG is an NSBB.
- NSBB and iron supplementation and/or blood transfusion, when indicated, are recommended as first-line therapy for chronic haemorrhage from PHG is an (I;1).
- In patients with transfusion-dependent PHG in whom NSBBs fail or are not tolerated, covered TIPS placement may be used provided the patient has no contraindication for TIPS (II-3;2).
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