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Management of portal hypertensive upper gastrointestinal bleeding: Report of the Coorg Consensus workshop of the Indian Society of Gastroenterology Task Force on Upper Gastrointestinal Bleeding

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Abstract

Portal hypertensive bleeding is a major complication of portal hypertension (PHT) with high morbidity and mortality. A lot of advances have been made in our understanding of screening, risk stratification, and management strategies for portal hypertensive bleeding including acute variceal bleeding leading to improved overall outcomes in patients with PHT. A number of guidelines on variceal bleeding have been published by various societies in the past few years. The Indian Society of Gastroenterology (ISG) Task Force on Upper Gastrointestinal Bleeding (UGIB) felt that it was necessary to bring out a standard practice guidance document for the use of Indian health care providers especially physicians, gastroenterologists, and hepatologists. For this purpose, an expert group meeting was convened by the ISG Task Force to deliberate on this matter and write a consensus guidance document for Indian practice. The delegates including gastroenterologists, hepatologists, radiologists, and surgeons from different parts of the country participated in the consensus development meeting at Coorg in 2018. A core group was constituted which reviewed all published literature on portal hypertensive UGIB with special reference to the Indian scenario and prepared unambiguous statements on different aspects for voting and consensus in the whole group. This consensus was produced through a modified Delphi process and reflects our current understanding and recommendations for the diagnosis and management of portal hypertensive UGIB in Indians. Intended for use by the health care providers especially gastroenterologists and hepatologists, these consensus statements provide an evidence-based approach to risk stratification, diagnosis, and management of patients with portal hypertensive bleeding.

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Funding

The members of the ISG Task Force on Upper Gastrointestinal Bleeding thank Kalinga Gastroenterology Foundation, Cuttack, India, and Zuventus Healthcare Limited, Mumbai, India, for providing unrestricted grants to conduct the Consensus workshop on Portal hypertensive bleeding.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, 753 001, India

    Shivaram P. Singh

  2. Department of Hepatology and Liver Transplant, Institute of Liver and Digestive Diseases, BLK Super Specialty Hospital, Delhi, 110 005, India

    Manav Wadhawan

  3. Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, 751 024, India

    Subrat K. Acharya

  4. Department of Gastroenterology and Hepatology, Fortis Flt. Lt. Rajan Dhall Hospital, Aruna Asaf Ali Marg, Vasant Kunj, New Delhi, 110 070, India

    Sawan Bopanna

  5. Department of Gastroenterology and Hepatology, Max Smart Super Specialty Hospital, Saket, New Delhi, 110 017, India

    Kaushal Madan

  6. Department of Medical Gastroenterology, IMS and SUM Hospital, K8 Kalinga Nagar, Shampur, Bhubaneswar, 751 003, India

    Manoj K. Sahoo

  7. Department of Gastroenterology and Hepatology, Aster CMI Hospital, Bangalore, 560 092, India

    Naresh Bhat

  8. Department of Gastroenterology and Hepatology, Moti Lal Nehru Medical College, Allahabad, 211 001, India

    Sri P. Misra

  9. Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Ajay Duseja & Sunil Taneja

  10. Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India

    Amar Mukund

  11. Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Patia, Bhubaneswar, 751 024, India

    Anil C. Anand

  12. Department of Hepatology, Christian Medical College, Vellore, 632 004, India

    Ashish Goel

  13. Department of Gastroenterology, MS Ramaiah Medical College, Bengaluru, 560 054, India

    Bonthala S. Satyaprakash

  14. Department of Hepatology and Transplant Hepatology, Institute of Liver Disease and Transplantation, Gleneagles Global Health City, 439, Cheran Nagar, Chennai, 600 100, India

    Joy Varghese

  15. Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, 751 019, India

    Manas K. Panigrahi

  16. Department of Gastroenterology, Asian Institute of Gastroenterology, Somajiguda, Hyderabad, 500 082, India

    Manu Tandan

  17. Department of Surgical Gastroenterology, Srirama Chandra Bhanja Medical College, Cuttack, 753 007, India

    Mihir K. Mohapatra

  18. Department of Gastroenterology and Hepatology, Fortis Escorts Liver and Digestive Diseases Institute, Okhla Road, New Delhi, 110 025, India

    Pankaj Puri

  19. Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, 400 008, India

    Pravin M. Rathi

  20. Department of Gastroenterology, Apollo BGS Hospital, Adichuchanagiri Road, Kuvempunagar, Mysore, 570 023, India

    Rajkumar P. Wadhwa

  21. Department of Gastroenterology, Malabar Medical College Hospital, Modakkallur, Calicut, 673 321, India

    Varghese Thomas

  22. Department of Hepatology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India

    Vikram Bhatia

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Consortia

Indian Society of Gastroenterology Task Force on Upper Gastrointestinal Bleeding

Contributions

SPS, SKA, MW, SB, and KM generated the initial list of statements. SPS and SKA constituted the core committee and coordinated with the participants for the consensus meeting/voting. MW, SB, KM, MKS, NB, SPM, AD, AM, ACA, AG, BSS, JV, MKP, MT, MKM, PP, PMR, RPW, ST, VT, and VB presented the statements with the evidence in the consensus meeting. All of these members and other delegate members of the ISG Task Force voted in the consensus meeting. All authors approved the manuscript.

Corresponding author

Correspondence to Shivaram P. Singh.

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Conflict of interest

MW, SKA, SB, KM, MKS, NB, SPM, AD, AM, ACA, AG, BSS, JV, KKP, MT, MKM, PP, PMR, RPW, ST, VT, VB, and ISG-TSFUGIB declare that they have no conflict of interest.

SPS owns stock for Sun Pharmaceutical Industries Ltd., Torrent Pharmaceuticals Ltd., Dr. Reddy's Laboratories, and Panacea Biotec.

Ethical statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

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Shivaram P Singh and Manav Wadhawan are first authors.

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Singh, S.P., Wadhawan, M., Acharya, S.K. et al. Management of portal hypertensive upper gastrointestinal bleeding: Report of the Coorg Consensus workshop of the Indian Society of Gastroenterology Task Force on Upper Gastrointestinal Bleeding. Indian J Gastroenterol 40, 519–540 (2021). https://doi.org/10.1007/s12664-021-01169-5

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