Portal hypertension and variceal bleeding--unresolved issues. Summary of an American Association for the study of liver diseases and European Association for the study of the liver single-topic conference.

摘要

Many randomized controlled trials (RCTs) have advanced the knowledge of the complications of portal hypertension, specifically in the management of varices and variceal hemorrhage. The end-points in most of these trials have used definitions attained at international consensus workshops that have been published in medical journals since the first Baveno conference in 1992. Three more international consensus' conferences have helped further define clinical endpoints and practice recommendations. This article summarizes the results of an Endpoints Single Topic Conference on "Portal Hypertension and Variceal Bleeding-Unresolved Issues" that took place in Atlanta, GA, in June 4-6, 2007 and that was sponsored jointly by the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver and constitutes the 6th international consensus conference in the area of varices and variceal hemorrhage. As outcomes have improved and knowledge has been gained, it is necessary to prioritize areas that require further research, to define surrogate markers of outcome and to stratify patients in different risk groups. These were the objectives of this single-topic conference. For areas in the management of varices and variceal hemorrhage in which it was decided that no further trials were necessary or plausible, practice recommendations were put forward. In some instances, these differed from recommendations put forward at the most recent consensus conference in Baveno 2004 and were incorporated into the recently published AASLD/ American College of Gastroenterology (ACG)-sponsored recommendations. Recommendations were obtained by majority agreement denned as agreement by greater than 70% of 23 expert participants (listed at the end of the article).