Narváez-Rivera R M, Cortez-Hernández C A, González-González J A, Tamayo-de la Cuesta J L, Zamarripa-Dorsey F, Torre-Delgadillo A, Rivera-Ramos J F J, Vinageras-Barroso J I, Muneta-Kishigami J E, Blancas-Valencia J M, Antonio-Manrique M, Valdovinos-Andraca F, Brito-Lugo P, Hernández-Guerrero A, Bernal-Reyes R, Sobrino-Cossío S, Aceves-Tavares G R, Huerta-Guerrero H M, Moreno-Gómez N, Bosques-Padilla F J
Servicio de Gastroenterología, Departamento de Medicina Interna, Hospital Universitario «Dr. José Eleuterio González», Monterrey, N.L., México.
Rev Gastroenterol Mex. 2013 Apr-Jun;78(2):92-113. doi: 10.1016/j.rgmx.2013.01.006. Epub 2013 May 9.
The aim of the Mexican Consensus on Portal Hypertension was to develop documented guidelines to facilitate clinical practice when dealing with key events of the patient presenting with portal hypertension and variceal bleeding. The panel of experts was made up of Mexican gastroenterologists, hepatologists, and endoscopists, all distinguished professionals. The document analyzes themes of interest in the following modules: preprimary and primary prophylaxis, acute variceal hemorrhage, and secondary prophylaxis. The management of variceal bleeding has improved considerably in recent years. Current information indicates that the general management of the cirrhotic patient presenting with variceal bleeding should be carried out by a multidisciplinary team, with such an approach playing a major role in the final outcome. The combination of drug and endoscopic therapies is recommended for initial management; vasoactive drugs should be started as soon as variceal bleeding is suspected and maintained for 5 days. After the patient is stabilized, urgent diagnostic endoscopy should be carried out by a qualified endoscopist, who then performs the corresponding endoscopic variceal treatment. Antibiotic prophylaxis should be regarded as an integral part of treatment, started upon hospital admittance and continued for 5 days. If there is treatment failure, rescue therapies should be carried out immediately, taking into account that interventional radiology therapies are very effective in controlling refractory variceal bleeding. These guidelines have been developed for the purpose of achieving greater clinical efficacy and are based on the best evidence of portal hypertension that is presently available.
《墨西哥门静脉高压共识》的目标是制定有文献依据的指南，以便在处理门静脉高压和静脉曲张出血患者的关键情况时促进临床实践。专家小组由墨西哥胃肠病学家、肝病学家和内镜医师组成，他们都是杰出的专业人士。该文件在以下模块中分析了相关主题：一级预防前和一级预防、急性静脉曲张出血以及二级预防。近年来，静脉曲张出血的管理有了显著改善。目前的信息表明，患有静脉曲张出血的肝硬化患者的总体管理应由多学科团队进行，这种方法对最终结果起着重要作用。初始管理建议采用药物和内镜治疗相结合的方法；一旦怀疑静脉曲张出血，应立即开始使用血管活性药物，并持续使用5天。患者病情稳定后，应由合格的内镜医师进行紧急诊断性内镜检查，然后进行相应的内镜下静脉曲张治疗。抗生素预防应被视为治疗的一个组成部分，在入院时开始并持续5天。如果治疗失败，应立即进行挽救治疗，同时考虑到介入放射学治疗在控制难治性静脉曲张出血方面非常有效。这些指南是为了实现更高的临床疗效而制定的，并且基于目前可得的关于门静脉高压的最佳证据。
