{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T22:57:15Z","timestamp":1772492235113,"version":"3.50.1"},"reference-count":33,"publisher":"FapUNIFESP (SciELO)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Gastroenterol."],"abstract":"<jats:p>ABSTRACT Since the publication of the Brazilian Association of Hepatology recommendations for the prevention and treatment of variceal bleeding in 2010, new evidence-based data were reported in the literature. This has changed our current management for portal hypertension. This review updates the previous recommendations. It takes the new prognostic staging of cirrhosis into account allowing tailored treatment for advanced fibrosis, compensated or decompensated cirrhosis. An organizing panel of five experts reviewed all recommendations according to available data, which were subsequently scrutinized by all members of the Brazilian Association of Hepatology using a web-based approach. The accepted recommendations are presented in this manuscript.<\/jats:p>","DOI":"10.1590\/s0004-2803.201700000-79","type":"journal-article","created":{"date-parts":[[2017,9,30]],"date-time":"2017-09-30T19:32:36Z","timestamp":1506799956000},"page":"349-355","source":"Crossref","is-referenced-by-count":14,"title":["VARICEAL BLEEDING: UPDATE OF RECOMMENDATIONS FROM THE BRAZILIAN ASSOCIATION OF HEPATOLOGY"],"prefix":"10.1590","volume":"54","author":[{"given":"Paulo Lisboa","family":"BITTENCOURT","sequence":"first","affiliation":[{"name":"Hospital Portugu\u00eas,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edna","family":"STRAUSS","sequence":"additional","affiliation":[{"name":"Hospital do Cora\u00e7\u00e3o de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto Queiroz","family":"FARIAS","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelo Alves de","family":"MATTOS","sequence":"additional","affiliation":[{"name":"Universidade Federal de Ci\u00eancias da Sa\u00fade de Porto Alegre,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edmundo Pessoa","family":"LOPES","sequence":"additional","affiliation":[{"name":"Universidade Federal de Pernambuco,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2017,10,2]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1053\/j.gastro.2009.01.043","article-title":"Simvastatin lowers portal pressure in patients with cirrhosis and portal hypertension a randomized controlled trial","volume":"136","author":"Abraldes JG","year":"2009","journal-title":"Gastroenterology"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1053\/j.gastro.2016.01.004","article-title":"Addition of simvastatin to standard therapy for the prevention of variceal rebleeding does not reduce rebleeding but increases survival in patients with cirrhosis","volume":"150","author":"Abraldes JG","year":"2016","journal-title":"Gastroenterology"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1111\/liv.13119","article-title":"Effect of propranolol on survival in patients with decompensated cirrhosis a nationwide study based Danish patient registers","volume":"36","author":"Bang UC","year":"2016","journal-title":"Liver Int"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1016\/j.gie.2011.06.030","article-title":"EUS-guided transesophageal treatment of gastric fundal varices with combined coiling and cyanoacrylate glue injection (with videos)","volume":"74","author":"Binmoeller KF","year":"2011","journal-title":"Gastrointest Endosc"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1590\/S0004-28032010000200017","article-title":"Pannel of the 1st Brazilian Consensus of Variceal Bleeding.Brazilian Society of Hepatology. Variceal bleeding consensus meeting report from the Brazilian Society of Hepatology","volume":"47","author":"Bittencourt PL","year":"2010","journal-title":"Arq Gastroenterol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.1002\/hep.28352","article-title":"Nonselective beta-blockers do not affect mortality in cirrhosis patients with ascites post hoc analysis of three RCTs with 1198 patients","volume":"63","author":"Bossen L","year":"2016","journal-title":"Hepatology"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1111\/liv.13277","article-title":"Prevention and treatment of variceal haemorrhage in 2017","volume":"37","author":"Brunner F","year":"2017","journal-title":"Liver Int"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/j.jhep.2011.07.005","article-title":"Non invasive evaluation of portal hypertension using transient elastography","volume":"56","author":"Castera L","year":"2012","journal-title":"J Hepatol"},{"key":"ref9","first-page":"738","article-title":"Schistosomal portal hypertension Randomized trial comparing endoscopic therapy alone or preceded by esophagogastric devascularization and splenectomy","volume":"15","author":"Costa Lacet CM","year":"2016","journal-title":"Ann Hepatol"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1111\/apt.12721","article-title":"Competing risks and prognostic stages of cirrhosis a 25-year inception cohort study of 494 patients","volume":"39","author":"D'Amico G","year":"2014","journal-title":"Aliment Pharmacol Ther"},{"key":"ref11","first-page":"743","article-title":"Expanding consensus in portal hypertension Report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension","volume":"63","author":"de Franchis R","year":"2015","journal-title":"J Hepatol"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1016\/j.jhep.2017.01.035","article-title":"The Baveno VI criteria to identify patients not requiring endoscopic surveillance for esophageal varices - Should we use it","volume":"66","author":"de Mattos AZ","year":"2017","journal-title":"J Hepatol"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"2370","DOI":"10.1056\/NEJMoa0910102","article-title":"Early use of TIPS in patients with cirrhosis and variceal bleeding","volume":"362","author":"Garcia-Pagan JC","year":"2010","journal-title":"N Engl J Med"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jhep.2012.08.020","article-title":"Use of early-TIPS for high-risk variceal bleeding results of a post-RCT surveillance study","volume":"58","author":"Garcia-Pagan JC","year":"2013","journal-title":"J Hepatol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1002\/hep.28906","article-title":"Portal hypertensive bleeding in cirrhosis Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases","volume":"65","author":"Garcia-Tsao G","year":"2017","journal-title":"Hepatology"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.cld.2014.01.002","article-title":"Gastric and ectopic varices","volume":"18","author":"Henry Z","year":"2014","journal-title":"Clin Liver Dis"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1002\/hep.28429","article-title":"Noncirrhotic complete obliterative portal vein thrombosis Novel management using trans-splenic transjugular intrahepatic portosystemic shunt with portal vein recanalization","volume":"63","author":"Kallini JR","year":"2016","journal-title":"Hepatology"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1136\/gutjnl-2013-306502","article-title":"Non-selective beta-blockers are associated with improved survival in patients with ascites listed for liver transplantation","volume":"64","author":"Leithead JA","year":"2015","journal-title":"Gut"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1016\/j.jhep.2016.01.031","article-title":"Keep the sick from harm in spontaneous bacterial peritonitis Dose of beta blockers matters","volume":"64","author":"Madsen BS","year":"2016","journal-title":"J Hepatol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1053\/j.gastro.2014.03.005","article-title":"Nonselective beta blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis","volume":"146","author":"Mandorfer M","year":"2014","journal-title":"Gastroenterology"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.jhep.2015.10.018","article-title":"CANONIC Study Investigators of the EASL-CLIF Consortium. Treatment with nonselective beta-blockers is associated with reduced severity of systemic inflammation and improved survival of patients with acute-on-chronic liver failure","volume":"64","author":"Mookerjee RP","year":"2016","journal-title":"J Hepatol"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1136\/gutjnl-2012-304038","article-title":"Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response to propranolol","volume":"62","author":"Reiberger T","year":"2013","journal-title":"Gut"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1111\/apt.12934","article-title":"Early-TIPS placement prevents rebleeding in high-risk patients with variceal bleeding, without improving survival","volume":"40","author":"Rudler M","year":"2014","journal-title":"Aliment Pharmacol Ther"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1002\/hep.27006","article-title":"Lack of difference among terlipressin, somatostatin, and octreotide in the control of acute gastroesophageal variceal hemorrhage","volume":"60","author":"Seo YS","year":"2014","journal-title":"Hepatology"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/j.jhep.2011.01.034","article-title":"Beta-blockers cause paracentesis-induced circulatory dysfunction in patients with cirrhosis and refractory ascites a crossover study","volume":"55","author":"Serste T","year":"2011","journal-title":"J Hepatol"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1002\/hep.23775","article-title":"Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites","volume":"52","author":"Serste T","year":"2010","journal-title":"Hepatology"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.jhep.2013.11.019","article-title":"Carvedilol vs esophageal variceal band ligation in the primary prophylaxis of variceal hemorrhage: a multicentre randomized controlled trial","volume":"60","author":"Shah HA","year":"2014","journal-title":"J Hepatol"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.jhep.2013.10.008","article-title":"The use of hemospray in portal hypertensive bleeding; a case series","volume":"60","author":"Smith LA","year":"2014","journal-title":"J Hepatol"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1016\/j.cgh.2014.11.019","article-title":"Risk of bacterial infection in patients with cirrhosis and acute variceal hemorrhage, based on Child-Pugh class, and effects of antibiotics","volume":"13","author":"Tandon P","year":"2015","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1053\/j.tvir.2016.01.006","article-title":"Portal Vein Recanalization and Transjugular Intrahepatic Portosystemic Shunt Creation for Chronic Portal Vein Thrombosis Technical Considerations","volume":"19","author":"Thornburg B","year":"2016","journal-title":"Tech Vasc Interv Radiol"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1002\/hep.23045","article-title":"Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed","volume":"50","author":"Tripathi D","year":"2009","journal-title":"Hepatology"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1211801","article-title":"Transfusion strategies for acute upper gastrointestinal bleeding","volume":"368","author":"Villanueva C","year":"2013","journal-title":"N Engl J Med"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1111\/j.1365-2036.2012.05088.x","article-title":"Meta-analysis vasoactive medications for the management of acute variceal bleeds","volume":"35","author":"Wells M","year":"2012","journal-title":"Aliment Pharmacol Ther"}],"container-title":["Arquivos de Gastroenterologia"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/pdf\/ag\/v54n4\/1678-4219-ag-s0004280320170000079.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2018,3,5]],"date-time":"2018-03-05T20:28:27Z","timestamp":1520281707000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0004-28032017000400349&lng=en&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,2]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2017,12]]}},"alternative-id":["S0004-28032017000400349"],"URL":"https:\/\/doi.org\/10.1590\/s0004-2803.201700000-79","relation":{},"ISSN":["1678-4219","0004-2803"],"issn-type":[{"value":"1678-4219","type":"electronic"},{"value":"0004-2803","type":"print"}],"subject":[],"published":{"date-parts":[[2017,10,2]]}}}