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UK guidelines on the management of variceal haemorrhage in cirrhotic patients
  1. Dhiraj Tripathi1,
  2. Adrian J Stanley2,
  3. Peter C Hayes3,
  4. David Patch4,
  5. Charles Millson5,
  6. Homoyon Mehrzad6,
  7. Andrew Austin7,
  8. James W Ferguson1,
  9. Simon P Olliff6,
  10. Mark Hudson8,
  11. John M Christie9
    1. 1Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
    2. 2GI Unit, Glasgow Royal Infirmary, Glasgow, UK
    3. 3Liver Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
    4. 4The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and University College London, London, UK
    5. 5Gastrointestinal and Liver Services, York Teaching Hospitals NHS Foundation Trust, York, UK
    6. 6Department of Interventional Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
    7. 7Department of Gastroenterology, Derby Hospitals NHS Foundation Trust, Derby, UK
    8. 8Liver Unit, Freeman Hospital, Newcastle upon Tyne, UK
    9. 9Department of Gastroenterology, Royal Devon and Exeter Hospital, Devon, UK
    1. Correspondence to Dr Dhiraj Tripathi, Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK; Dhiraj.Tripathi{at}, d.tripathi{at}


    These updated guidelines on the management of variceal haemorrhage have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines which this document supersedes were written in 2000 and have undergone extensive revision by 13 members of the Guidelines Development Group (GDG). The GDG comprises elected members of the BSG liver section, representation from British Association for the Study of the Liver (BASL) and Liver QuEST, a nursing representative and a patient representative. The quality of evidence and grading of recommendations was appraised using the AGREE II tool.

    The nature of variceal haemorrhage in cirrhotic patients with its complex range of complications makes rigid guidelines inappropriate. These guidelines deal specifically with the management of varices in patients with cirrhosis under the following subheadings: (1) primary prophylaxis; (2) acute variceal haemorrhage; (3) secondary prophylaxis of variceal haemorrhage; and (4) gastric varices. They are not designed to deal with (1) the management of the underlying liver disease; (2) the management of variceal haemorrhage in children; or (3) variceal haemorrhage from other aetiological conditions.


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