Table 12.

Treatment of acute or chronic gastrointestinal bleeding from portal hypertensive gastropathy

Acute bleeding

Patient stabilization

Treat severe coagulopathy with highly elevated INR associated with cirrhosis with fresh frozen plasma

Treat severe thrombocytopenia associated with hypersplenism and bone marrow suppression from alcoholism with platelet transfusions

Transfuse packed erythrocytes to main hemoglobin level at about 8 g/dL

Consider antibiotic prophylaxis in patient with cirrhosis

Endoscopic therapy from bleeding-rarely used

Consider argon plasma coagulation

Hemospray - an experimental therapy

Pharmacotherapy

Octreotide - first line therapy

Vasopressin or terlipressin - second line therapy

Proton pump inhibitor therapy - adjunct therapy

Propranolol - can be instituted after bleeding controlled and patient stabilized

Interventional therapy

TIPS - for uncontrolled hemorrhage or for bleeding from PHG associated with variceal bleeding

Liver transplantation - for advanced end stage liver disease

Chronic bleeding

Treatment of anemia

Transfusions of packed erythrocytes as necessary

Iron replacement therapy

Pharmacotherapy

Consider propranolol

TIPS: Transjugular intrahepatic portosystemic shunt; PHG: Portal hypertensive gastropathy; INR: International normalized ratio.