The importance of accurate diagnosis and vigorous care of the patient with liver disease and gastrointestinal hemorrhage.

Gastrointestinal hemorrhage in the patient with liver disease is often massive and life threatening. Although varices are the most likely cause of hemorrhage, other sources, such as peptic ulcer disease, Mallory-Weiss tears, and portal hypertensive gastropathy, are common. As liver disease is an important risk factor for intractable bleeding and death in patients with gastrointestinal hemorrhage, outcome in these patients is often poor regardless of the cause of the bleeding. Essential elements of initial therapy include prompt and adequate intravascular volume replacement, correction of severe anemia and coagulopathies, and adequate airway management. After initial resuscitation, urgent endoscopy is required to secure the diagnosis and to deliver endoscopic therapy if possible. The specific form of therapy will differ depending on the lesion encountered. Adjunctive measures, such as the administration of antibiotics and drugs that reduce portal pressure, including octreotide, may also improve outcome. Clinical and endoscopic information can be used to predict first bleeding in patients with liver disease. A large body of data supports the use of beta-blockers in the prevention of first bleeding in patients with known varices.