Treatment Summary Form for Gastrointestinal Bleeding Due to Ruptured Esophageal or Gastric Varices

1. Definition

Gastrointestinal bleeding due to ruptured esophageal or gastric varices is a condition in which sudden bleeding occurs when dilated veins in the esophagus or the gastric fundus rupture. These varices are caused by increased portal vein pressure, which commonly occurs in patients with cirrhosis.

This is a severe medical emergency that requires immediate hospitalization. Without prompt treatment, it can be life-threatening.

2. Symptoms

Sudden vomiting of fresh blood.
Black stools, or in some cases, dark red or maroon bloody stools when the bleeding is severe.
Pale skin due to acute blood loss and anemia.
Fainting or dizziness.
Signs associated with cirrhosis, such as jaundice, ascites, and leg edema.

3. Diagnosis of Gastrointestinal Bleeding Due to Ruptured Esophageal Varices

Based on the symptoms described above, whether or not the patient has previously been diagnosed with cirrhosis.
Blood tests: complete blood count, particularly hemoglobin (Hb) to assess anemia, as well as liver and kidney function tests to assess disease severity and prognosis.
Esophagogastroduodenoscopy (EGD): the primary diagnostic method for identifying esophageal or gastric varices and, when indicated, providing endoscopic treatment.
In some cases, additional specialized tests and procedures may be required to confirm the diagnosis and assess disease severity.

4. Treatment

Blood transfusion and intravenous fluids: Packed red blood cells and isotonic sodium chloride solution may be administered to replace blood loss, address hypotension, and restore circulating blood volume.
Antibiotic prophylaxis to prevent infection.
Vasoactive medications to reduce portal pressure, such as octreotide and terlipressin.
Early esophagogastroduodenoscopy (EGD): Endoscopic hemostasis may be performed by band ligation of esophageal varices using rubber bands or by injecting tissue adhesive (Histoacryl) into gastric varices, as appropriate. Current guidance supports early endoscopy after initial stabilization in suspected acute variceal bleeding.

5. Other Treatment Methods

These approaches may be considered when bleeding cannot be controlled with endoscopic therapy:

Transjugular Intrahepatic Portosystemic Shunt (TIPS): a procedure that creates a shunt between the portal venous system and the hepatic venous circulation within the liver to reduce portal hypertension. TIPS may be considered when bleeding cannot be controlled with pharmacological and endoscopic treatment.
Angiographic intervention: vascular imaging may be performed to identify the bleeding source and enable embolization of the bleeding vessel when bleeding cannot be controlled by other methods.

6. Prevention of Recurrent Bleeding After a Bleeding Episode

Patients should undergo regular follow-up after discharge and take medications to prevent recurrent bleeding, such as propranolol or carvedilol, as prescribed. These medications should be taken continuously according to the treating physician’s instructions.
Patients should undergo periodic esophagogastroduodenoscopy (EGD) as recommended by their physician to monitor the status of esophageal or gastric varices and determine the appropriate preventive treatment plan.
Adherence to follow-up appointments and cirrhosis management is essential to reduce the risk of recurrent complications. For patients who have recovered from an episode of variceal bleeding, secondary prevention generally involves appropriate pharmacological therapy and/or serial endoscopic treatment, depending on the type of varices and the individual clinical condition.

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.