Mexican consensus on the approach to and treatment of acute variceal bleeding
Bibliographic record
Abstract
Portal hypertension is the main consequence of cirrhosis and the cause of most of its complications, such as ascites, variceal bleeding, and hepatic encephalopathy. The development of those complications marks the transition from compensated cirrhosis to decompensated cirrhosis, and the latter is associated with poor prognosis. Approximately 50% of cirrhotic patients have gastroesophageal varices. Acute variceal bleeding (AVB) is a medical emergency with high mortality rates ranging from 15 to 25% within 6 weeks. AVB management has evolved in recent years due to new evidence on fluid resuscitation and transfusion support, advances in endoscopic techniques, esophageal stent use, and transjugular intrahepatic portosystemic shunt (TIPS) placement. This consensus aimed to establish recommendations based on the best available evidence and expert opinion from Mexican specialists in gastroenterology for the diagnosis, management, and treatment of AVB in patients with portal hypertension. The goal was to improve clinical decision-making, reduce the associated mortality, and standardize care protocols across the different levels of medical care in Mexico. Seventeen national and 3 international experts were divided into five working groups to address five thematic areas: 1) initial evaluation, 2) fluid resuscitation and initial pharmacologic therapy, 3) the role of endoscopy, 4) strategies for managing failed bleeding control, and 5) secondary prophylaxis recommendations. The consensus was developed utilizing the RAND/UCLA process, with a modified Delphi method. A total of 28 statements were produced, with specific recommendations on initial fluid resuscitation and transfusion strategy, and highlighting the importance of vasopressor use, the role of endoscopy, and AVB prophylaxis. This first Mexican Consensus on Acute Variceal Bleeding establishes practical recommendations for standardizing AVB management in patients with cirrhosis in Mexico, from the initial evaluation to secondary prophylaxis, emphasizing the importance of specific strategies and laying the groundwork for future research. La hipertensión portal (HTP) es la principal consecuencia de la cirrosis y la causa de la mayoría de sus complicaciones como: ascitis, hemorragia variceal y encefalopatía hepática (EH). El desarrollo de estas complicaciones define la transición de cirrosis compensada a descompensada, esta última con un pobre pronóstico. Alrededor del 50% de los pacientes con cirrosis tienen várices gastroesofágicas. La hemorragia variceal aguda (AVB) es una emergencia que conlleva una elevada mortalidad, siendo del 15% al 25% a las 6 semanas. El manejo de la AVB ha cambiado en los últimos años con la nueva evidencia sobre la reanimación hídrica y soporte transfusional, la implementación de nuevas técnicas de endoscopia, el uso de prótesis esofágicas y la colocación de derivación portosistémica intrahepática transyugular (TIPS). El objetivo de este consenso fue establecer recomendaciones basadas en la mejor evidencia disponible y en la opinión de expertos nacionales en gastroenterología para el diagnóstico, manejo y tratamiento de la AVB en pacientes con HTP, con el fin de mejorar la toma de decisiones clínicas, reducir la mortalidad asociada, y estandarizar los protocolos de actuación en los distintos niveles de atención médica en México. Para lo anterior, se integraron 5 mesas de trabajo con participación de 17 expertos nacionales y 3 internacionales, se abordaron cinco ejes temáticos: 1) evaluación inicial, 2) resucitación y terapia farmacológica inicial, 3) papel de la endoscopia, 4) estrategias en la falla de control de la hemorragia y 5) recomendaciones de profilaxis secundaria. El consenso fue elaborado mediante el proceso RAND/UCLA con el método Delphi modificado. El resultado de este documento generó un total de 28 enunciados. Se generan recomendaciones especificas sobre la reanimación hidríca inicial y la estrategia de transfusiones. Destaca la importancia sobre uso de vasopresores, papel de la endoscopia y la profilaxis de la AVB. El Primer Consenso Mexicano sobre Hemorragia Variceal Aguda establece recomendaciones prácticas para estandarizar su manejo en pacientes con cirrosis en México, desde la evaluación inicial hasta la profilaxis secundaria, destacando la importancia de estrategias específicas y sentando bases para futuras investigaciones.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.051 | 0.062 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.005 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".