Hemorragia digestiva variceal: epidemiología, patogénesis, manejo y profilaxis

P. Martin Padilla-Machaca; Sergio Padilla Gonzales; Maria Grazia Venturelli Romero; Maria Cecilia Cabrera Cabrejos

doi:10.47892/rgp.2025.453.2038

Autores/as

P. Martin Padilla-Machaca Universidad Nacional Mayor de San Marcos, Lima, Perú; Unidad de Hígado, Hospital Nacional Guillermo Almenara, Lima, Perú. https://orcid.org/0000-0002-3585-3666
Sergio Padilla Gonzales Facultad de Medicina Humana, Universidad de Piura, Lima, Perú. https://orcid.org/0009-0006-1714-4416
Maria Grazia Venturelli Romero Unidad de Hígado, Hospital Nacional Guillermo Almenara, Lima, Perú. https://orcid.org/0000-0002-9256-6444
Maria Cecilia Cabrera Cabrejos Universidad Nacional Mayor de San Marcos, Lima, Perú; Unidad de Hígado, Hospital Nacional Guillermo Almenara, Lima, Perú. https://orcid.org/0000-0002-3249-9737

DOI:

https://doi.org/10.47892/rgp.2025.453.2038

Palabras clave:

Hemorragia Gastrointestinal, Hipertensión Portal, Cirrosis Hepática, Varices Esofágicas y Gástricas

Resumen

La hemorragia digestiva variceal es una de las principales complicaciones de la hipertensión portal en pacientes con cirrosis. Afecta a pacientes con cirrosis descompensada, y su aparición marca un punto de inflexión en la evolución de la enfermedad hepática. Pese a los avances terapéuticos, persisten desafíos en el manejo integral, especialmente en escenarios con recursos limitados. El tratamiento busca controlar el sangrado activo, prevenir el resangrado temprano y reducir la mortalidad. Esta revisión resume la evidencia reciente sobre fisiopatología, diagnóstico y manejo actualizado de la hemorragia digestiva variceal, incluyendo estrategias emergentes como la terapia vasoactiva precoz, el uso racional de transfusiones, la profilaxis antibiótica y el papel clave de la endoscopía oportuna; además de destacar la importancia de identificar la hipertensión portal clínicamente significativa para prevenir complicaciones y mejorar los desenlaces clínicos.

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