UK guidelines on the Management of Variceal Haemorrhage in Cirrhotic Patients

Guidelines for acute gastrointestinal bleeding

The BSG guidelines for acute variceal and non-variceal haemorrhage were written 8 and 6 years ago and have become dated. Acute upper gastrointestinal bleeding is a major emergency and the recent National, UK-wide audit demonstrated significant deficiencies in service provision and care, and it is therefore appropriate to update the evidence base for managing acutely bleeding patients. The Scottish Inter-collegiate Guideline Network (SIGN) have, this year, published their guideline ‘Management of Acute Upper and Lower GI Bleeding’. This well researched document covers modern management of varices, non-variceal upper gastrointestinal and acute colonic bleeding. Rather than council commissioning further working parties and guideline groups to revise the BSG bleeding guidelines we have decided to commend the SIGN document and adopt it as standard of care for these conditions. The SIGN guideline can be found here

FOR REFERENCE: BSG guidelines on the management of variceal haemorrhage in cirrhotic patients - 2000

R Jalan, P C Hayes


These guidelines on the management of variceal haemorrhage were commissioned by the British Society of Gastroenterology under the auspices of the Liver Section. They were written in June 1998 and have been corrected and agreed upon by the members of the Liver Section.The nature of variceal haemorrhage in cirrhotic patients with its complex range of complications makes rigid guidelines inappropriate.
Over the past few years there have been numerous advances in the management of variceal haemorrhage in patients with cirrhosis. These have included better endoscopic techniques with the widespread availability of video endoscopy, establishment of variceal band ligation,availability of newer drugs such as somatostatin and vasopressin analogues, better surgical techniques, and finally the availability of transjugular intrahepatic portosystemic stent shunt (TIPSS).
These guidelines deal specifically with the management of varices in patients with cirrhosis and are not designed to address:
(1) the management of the underlying liver disease;
(2) the management of variceal haemorrhage in children; or
(3) variceal haemorrhage from other aetiological conditions.

Read the entire document as a pdf below.

Click to view page 15: References 182-208 [omitted from.pdf file]