Bleeding Oesophageal Varices

Description

General and supportive measures

Medicine treatment

Referral

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ICD-10 code: I85.0

DESCRIPTION

Presentation with haematemesis (fresh blood) or melaena in a patient who has a spontaneous bleed from varices at the oesophageal-gastric junction. The patient may or may not have been known to have chronic liver disease and portal hypertension. This bleeding may be hard to control and be life threatening.

GENERAL AND SUPPORTIVE MEASURES

• Resuscitation and blood transfusion as required.
• For local control of acute bleeds that are not controlled with medicine treatment: Sengstaken tube.
• For secondary prophylaxis after a bleed: refer for endoscopic injection sclerotherapy or variceal banding every 2 weeks until eradicated.
• If either or both treatments fail: surgical over-sewing.

MEDICINE TREATMENT

• Octreotide, IV, bolus, 1–2 µg/kg immediately then 1–5 µg/kg/hour by infusion. (Specialist initiated).

LoE III ⁸

Post bleed prophylactic management

• Proton pump inhibitor, e.g.:
  • Omeprazole, oral, 0.7-1.4 mg/kg/day once daily. Specialist initiated.
    • Maximum dose: 20-40 mg/dose.
      If 1 month to < 2 years:   5 mg once daily.
      If  2 to < 7 years:   10 mg once daily.
      If  7–12 years:    20 mg once daily.

LoE III ⁷

AND

• Propranolol, oral, 2 mg/kg daily in 3 divided doses.
  • If needed, increase dose to 8 mg/kg/24 hours.
  • Aim to reduce the resting pulse rate by 25%.

REFERRAL

• All, to establish diagnosis and initiate treatment.
• Bleeding varices: only after commencement of resuscitation and octreotide, if available.

Click here for the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024 

Chapter 2: Alimentary Tract, 2.3 Hepatic Disease, 2.3.3.1 Bleeding Oesophageal Varices