Higuera-de-la-Tijera F, Noble-Lugo A, Crespo J, Albillos A, Montaño-Loza A J, Cano-Contreras A D, Castro-Narro G E, De Giau-Triulzi L F, García-Jiménez E S, Fernández-Pérez N J, Aldana-Ledesma J M, Trujillo-Benavides O E, Cerna-Cardona J, Velasco-Santiago Y M, Cerda-Reyes E, Tapia-Calderón D K, Bautista-Santos A, Pérez-Hernández J L, Moreno-Alcántar R, Velarde-Ruiz Velasco J A
Servicio de Gastroenterología y Hepatología, Hospital General de México «Dr. Eduardo Liceaga», Mexico City, Mexico.
Servicio de Gastroenterología, Hospital Español, Mexico City, Mexico.
Rev Gastroenterol Mex (Engl Ed). 2025 Jul-Sep;90(3):451-473. doi: 10.1016/j.rgmxen.2025.09.007. Epub 2025 Sep 15.
Portal hypertension is the main consequence of cirrhosis and the cause of most of its complications, such as ascites, variceal bleeding, and hepatic encephalopathy. The development of those complications marks the transition from compensated cirrhosis to decompensated cirrhosis, and the latter is associated with poor prognosis. Approximately 50% of cirrhotic patients have gastroesophageal varices. Acute variceal bleeding (AVB) is a medical emergency with high mortality rates ranging from 15 to 25% within 6 weeks. AVB management has evolved in recent years due to new evidence on fluid resuscitation and transfusion support, advances in endoscopic techniques, esophageal stent use, and transjugular intrahepatic portosystemic shunt (TIPS) placement. This consensus aimed to establish recommendations based on the best available evidence and expert opinion from Mexican specialists in gastroenterology for the diagnosis, management, and treatment of AVB in patients with portal hypertension. The goal was to improve clinical decision-making, reduce the associated mortality, and standardize care protocols across the different levels of medical care in Mexico.
Seventeen national and 3 international experts were divided into five working groups to address five thematic areas: 1) initial evaluation, 2) fluid resuscitation and initial pharmacologic therapy, 3) the role of endoscopy, 4) strategies for managing failed bleeding control, and 5) secondary prophylaxis recommendations. The consensus was developed utilizing the RAND/UCLA process, with a modified Delphi method.
A total of 28 statements were produced, with specific recommendations on initial fluid resuscitation and transfusion strategy, and highlighting the importance of vasopressor use, the role of endoscopy, and AVB prophylaxis.
This first Mexican Consensus on Acute Variceal Bleeding establishes practical recommendations for standardizing AVB management in patients with cirrhosis in Mexico, from the initial evaluation to secondary prophylaxis, emphasizing the importance of specific strategies and laying the groundwork for future research.
门静脉高压是肝硬化的主要后果，也是其大多数并发症的病因，如腹水、静脉曲张出血和肝性脑病。这些并发症的出现标志着从代偿期肝硬化向失代偿期肝硬化的转变，而失代偿期肝硬化预后较差。约50%的肝硬化患者有胃食管静脉曲张。急性静脉曲张出血（AVB）是一种医疗急症，6周内死亡率高达15%至25%。近年来，由于液体复苏和输血支持方面的新证据、内镜技术的进步、食管支架的使用以及经颈静脉肝内门体分流术（TIPS）的应用，AVB的管理发生了演变。本共识旨在根据墨西哥胃肠病学专家的最佳现有证据和专业意见，为门静脉高压患者AVB的诊断、管理和治疗制定建议。目标是改善临床决策，降低相关死亡率，并使墨西哥不同医疗水平的护理方案标准化。
17名国内专家和3名国际专家分为五个工作组，以处理五个主题领域：1）初始评估；2）液体复苏和初始药物治疗；3）内镜检查的作用；4）控制出血失败的管理策略；5）二级预防建议。该共识采用兰德/加州大学洛杉矶分校流程和改良的德尔菲法制定。
共产生了28条声明，对初始液体复苏和输血策略提出了具体建议，并强调了血管升压药使用的重要性、内镜检查的作用以及AVB预防。
这份关于急性静脉曲张出血的首个墨西哥共识为墨西哥肝硬化患者AVB管理的标准化制定了实用建议，从初始评估到二级预防，强调了特定策略的重要性，并为未来研究奠定了基础。
