Diagnosis and management of acute XXXX : Asian Pacific Association for Study of the Liver recommendations.

@entity1 @entity101 @entity548 @entity6552 @entity2886 @entity99
BACKGROUND: Acute @entity548 (AVB) is a medical emergency and associated with a mortality of 20% at 6  weeks. Significant advances have occurred in the recent past and hence there is a need to update the existing consensus guidelines. There is also a need to include the literature from the Eastern and Asian countries where majority of @entity1 with @entity101 ( @entity101 ) live. METHODS: The expert working party, predominantly from the Asia-Pacific region, reviewed the existing literature and deliberated to develop consensus guidelines. The working party adopted the Oxford system for developing an evidence-based approach. Only those statements that were unanimously approved by the experts were accepted. RESULTS: AVB is defined as a bleed in a known or suspected case of @entity101 , with the presence of @entity6552 within 24  h of presentation, and/or ongoing melena, with last melanic stool within last 24  h. The time frame for the AVB episode is 48  h. AVB is further classified as active or inactive at the time of endoscopy. Combination therapy with vasoactive drugs (<30  min of hospitalization) and endoscopic variceal ligation (door to scope time <6  h) is accepted as first-line therapy. Rebleeding (48  h of T (0)) is further sub-classified as very early rebleeding (48 to 120  h from T (0)), early rebleeding (6 to 42  days from T (0)) and late rebleeding (after 42  days from T (0)) to maintain uniformity in clinical trials. Emphasis should be to evaluate the role of adjusted blood requirement index (ABRI), assessment of associated comorbid conditions and poor predictors of non-response to combination therapy, and proposed APASL (Asian Pacific Association for Study of the Liver) Severity Score in assessing these @entity1 . Role of hepatic venous pressure gradient in AVB is considered useful. Antibiotic ( @entity2886 ) prophylaxis is recommended and search for acute @entity99 should be done. New guidelines have been developed for management of variceal bleed in @entity1 with non-cirrhotic @entity101 in pediatric @entity1 . CONCLUSION: Management of acute @entity548 in Asia-Pacific region needs special attention for uniformity of treatment and future clinical trials.
