UK guidelines on the management of variceal haemorrhage in cirrhotic patients

TLDR

Updated UK guidelines on variceal haemorrhage in cirrhosis, superseding the 2000 version, were commissioned by the BSG Clinical Services and Standards Committee and revised by 13 members, acknowledging the complex nature of the condition. The guidelines were developed by a multidisciplinary BSG liver section group, graded with AGREE II, and cover primary prophylaxis, acute and secondary variceal haemorrhage, and gastric varices, while excluding underlying liver disease, pediatric cases, and non‑cirrhotic etiologies.

Abstract

These updated guidelines on the management of variceal haemorrhage have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines which this document supersedes were written in 2000 and have undergone extensive revision by 13 members of the Guidelines Development Group (GDG). The GDG comprises elected members of the BSG liver section, representation from British Association for the Study of the Liver (BASL) and Liver QuEST, a nursing representative and a patient representative. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. The nature of variceal haemorrhage in cirrhotic patients with its complex range of complications makes rigid guidelines inappropriate. These guidelines deal specifically with the management of varices in patients with cirrhosis under the following subheadings: (1) primary prophylaxis; (2) acute variceal haemorrhage; (3) secondary prophylaxis of variceal haemorrhage; and (4) gastric varices. They are not designed to deal with (1) the management of the underlying liver disease; (2) the management of variceal haemorrhage in children; or (3) variceal haemorrhage from other aetiological conditions.