Treatment of gastrointestinal bleeding due to portal hypertension

The article was consulted professionally with MSc Vu Tan Phuc - Department of Medical Examination & Internal Medicine, Vinmec Phu Quoc International General Hospital.

Gastrointestinal bleeding is a condition in which blood from the blood vessels of the gastrointestinal tract escapes from the lumen, causing vomiting or bloody stools.
Gastrointestinal bleeding requires emergency treatment including medical and surgical treatment. To treat, it is necessary to first determine the upper or lower gastrointestinal bleeding, then, evaluate the degree of gastrointestinal bleeding to provide appropriate management. Gastrointestinal bleeding is classified into 3 levels based on the following indicators:
Grade I (Mild): Blood loss <500ml (10%), pulse <100l/min, systolic blood pressure >90mmHg, HC >30%, Hct > 3 million/mm3, patient is alert and only slightly tired. Grade II (Moderate): Blood loss <1500ml (30%), pulse >100-120l/min, systolic blood pressure between 80-90mmHg, HC <20-30%, Hct 2 - 3 million/mm3, Patients have symptoms of dizziness, pale skin, pale mucous membranes, excessive sweating, little urine. Grade III (Severe): Blood loss >1500ml (30%), pulse >120l/min, systolic blood pressure <80mmHg, HC <20%, Hct 2 million/mm3, patient has symptoms of syncope, lethargy, panic.

Risk of developing esophageal varices: occurs in patients with venous pressure (HVPG) >10 mmHg at screening. The risk of developing small to large esophageal varices is in patients with alcoholic cirrhosis, or end stage cirrhosis (decompensated cirrhosis). Risk of gastrointestinal bleeding when liver function declines, patients continue to use stimulants such as beer, alcohol, patients have acid reflux. Risk of rupture of esophageal varices causing gastrointestinal bleeding, especially in patients with end-stage cirrhosis.

Treatment of gastrointestinal bleeding due to portal hypertension includes:
First aid and evaluation, ensuring ABC steps: placing the patient in a low lying position, breathing oxygen, ... Returning the circulatory volume: Equipment Establish 2 lines as soon as possible, including fluids and blood transfusions (if indicated) because gastrointestinal bleeding can suddenly become severe. The infusion should use readily available isotonic solutions. Infusion of blood products is used in cases of severe gastrointestinal bleeding. The infusion rate should be adjusted according to the patient's condition for the purpose of maintaining vitals, however, it should be noted not to raise the systolic blood pressure >149mmHG to prevent recurrent bleeding, and be especially cautious in the patient. Patients with hypertension, chronic anemia, chronic kidney failure, heart failure, ...

Treatment of hemostasis: There are methods of hemostasis treatment, that is, using drugs to reduce portal pressure, endoscopic esophageal sphincter and hemostatic tube blocker. The goal of portal hypertension (Octreotide, Somatostatin, Terlipressin) is to control and prevent recurrent gastrointestinal bleeding. The drug is used as soon as the patient is suspected of gastrointestinal bleeding due to portal hypertension and used for 3 - 5 days (when indicated). With the mechanism of visceral vasoconstriction, reducing blood flow through the portal vein, thereby reducing portal pressure, using drugs to temporarily stop bleeding up to 80%. Endoscopic hemostasis is indicated as soon as possible, within up to 12 hours, as soon as hemodynamically stable, with signs of bleeding such as dilated esophageal veins, blood clots clot on the venous wall, the “nipple” sign. The combination of portal depressurization and endoscopic esophageal sphincter is considered the gold standard in hemostasis treatment. Endoscopic catheter blockade is indicated in cases of severe gastrointestinal bleeding, massive bleeding, as a temporary method of stopping bleeding while waiting for other radical treatments.

Other treatment: Prevention of infection with antibiotics, prevention of hepatic coma and PPIs after endoscopic therapy. Gastrointestinal bleeding due to portal hypertension is a dangerous complication and is the leading cause of death. Hemostatic therapy is an important step in the treatment of gastrointestinal bleeding due to portal hypertension. Therefore, when performing this procedure, the patient needs to choose a reputable address, with full facilities and modern machinery, to avoid dangerous complications during the procedure.