Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, Virginia.
Division of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
Clin Gastroenterol Hepatol. 2021 Jun;19(6):1098-1107.e1. doi: 10.1016/j.cgh.2021.01.027. Epub 2021 Jan 22.
Management of bleeding gastric varices (GV) presents a unique challenge for patients with portal hypertension. Despite over thirty years of diagnostic and treatment advances standardized practices for bleeding GV are lacking and unsupported by adequate evidence. There are no definitive natural history studies to help with risk assessment or prospective clinical trials to guide clinical decision making. Available literature on the natural history and management of gastric varices consists of case series, restricted cohort studies, and a few small randomized trials, all of which have significant selection biases. This review summarizes the available data and recommendations based on expert opinion on how best to diagnose and manage bleeding from gastric varices. Table 1 summarizes our recommendations.
管理胃静脉曲张（GV）出血对门脉高压患者提出了独特的挑战。尽管在诊断和治疗方面取得了三十多年的进展，但缺乏针对出血性 GV 的标准化实践，也没有足够的证据支持这些实践。没有明确的自然病史研究来帮助评估风险，也没有前瞻性临床试验来指导临床决策。有关胃静脉曲张的自然病史和管理的现有文献包括病例系列、受限队列研究和少数小型随机试验，但都存在严重的选择偏倚。本综述根据专家意见总结了有关如何最好地诊断和治疗胃静脉曲张出血的现有数据和建议。表 1 总结了我们的建议。
