Acute Gastrointestinal Bleeding
Authors: Meeta Prasad Kerlin, Jeffrey L. Tokar
Journal: Annals of Internal Medicine (2013)

LettersDecember 3, 2013Acute Gastrointestinal BleedingMeeta Prasad Kerlin, MD, MSCE and Jeffrey L. Tokar, MDMeeta Prasad Kerlin, MD, MSCEFrom The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and Fox Chase Cancer Center, Philadelphia, Pennsylvania. and Jeffrey L. Tokar, MDFrom The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and Fox Chase Cancer Center, Philadelphia, Pennsylvania.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-159-11-201312030-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Regarding management of patients with varices, Drs. Feuerstein and Leffler accurately point out that the AASLD does not advocate nonselective β-blockers for primary prophylaxis of variceal bleeding for all patients with chronic liver disease, only those with higher-risk varices. We agree that, in our practices, many patients with small, low-risk varices typically do not routinely receive these agents for primary prophylaxis. That said, the AASLD guidelines (1) do not recommend that patients with small varices should never receive β-blockers but state that "prophylaxis with beta-blockers should be used in patients with small varices who are at high risk ...References1. Garcia-Tsao G, Sanyal AJ, Grace ND, and Carey WD; Practice Guidelines Committee of American Association for Study of Liver Diseases. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007;102:2086-102. [PMID: 17727436] CrossrefMedlineGoogle Scholar2. Garcia-Tsao G and Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med. 2010;362:823-32. [PMID: 20200386] CrossrefMedlineGoogle Scholar3. Martí M, Artigas JM, Garzón G, Alvarez-Sala R, and Soto JA. Acute lower intestinal bleeding: feasibility and diagnostic performance of CT angiography. Radiology. 2012;262:109-16. [PMID: 22084211] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and Fox Chase Cancer Center, Philadelphia, Pennsylvania.Disclosures: Dr. Kerlin: Consulting fee or honorarium: American College of Physicians; Grants/grants pending: National Heart, Lung, and Blood Institute, Centers for Disease Control and Prevention. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAcute Gastrointestinal Bleeding Meeta Prasad Kerlin and Jeffrey L. Tokar Acute Gastrointestinal Bleeding Joseph D. Feuerstein and Daniel A. Leffler Metrics December 3, 2013Volume 159, Issue 11Page: 793-794KeywordsAngiographyChronic liver diseaseColonoscopyComputed axial tomographyEsophagusHemorrhageLiver diseasesNecrosisPatient advocacyProphylaxis ePublished: 3 December 2013 Issue Published: December 3, 2013 CopyrightCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...