Gastroenterology Critical Care

Garcia-Tsao, Sanyal A, Grace N, et al. Practice Guidelines Committee of the American Association for the Study of Liver Diseases and the Practice Parameters Committee of the American College of Gastroenterology.  Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis.  Am J Gastroenterol 2007;102:2086–2102.  Thorough update of the current practice guidelines for the treatment of varices, including use of antibiotics, octreotide, and IV PPI in the intensive care setting. 
PMID:  17879356
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García-Pagán JC, Caca K, Bureau C, et al. for the Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group.  Early use of TIPS in patients with cirrhosis and variceal bleeding.  N Engl J Med 2010;362:2370-9.  In a prospective study of 63 patients with acute variceal bleeding, TIPS placement within 72 hours led to a reduction in mortality and rebleeding rate.
PMID: 20573925
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Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999;341:403-9. RCT found addition of albumin to cefotaxime vs. antibiotic alone in above population preserved renal function and reduced mortality. Study does not provide information on volume resuscitation in the antibiotic-alone group, however, making it less clear whether albumin has additional benefit beyond what could be achieved with aggressive IVF.
PMID:  10432325
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