Abordagem das varizes de esôfago no paciente pediátrico cirrótico: rastreamento, profilaxia primária e conduta no sangramento agudo

Abstract

The gastrointestinal bleeding from ruptured varices is the leading cause of morbidity and mortality in the cirrhotic patient.The knowledge of the evolution of portal hypertension and the natural story of gastro-esophageal varices allows a better approach to the cirrhotic patient that includes: screening for varices with high risk of bleeding and recommendation of primary prophylaxis for gastrointestinal bleeding. If the bleeding occurs, the approach must be immediate using known protocols. This conduct is well established in the cirrhotic adult. In children due to the limited number of studies the management is based in adult protocols, which could not be adequate to this age range. It was made a non systematic review of scientific literature from 1998 due 2018, available in MEDLINE, PUBMED, Elsevier, Web of Science, Scielo and Lilacs.Although there is no clear recommendation about the screening for varices, there is an agreement to do an endoscopy in children with clinical or laboratory signs of portal hypertension and begin the primary prophylaxis in esophageal varices of medium-size and large-size. In the regard of the acute bleeding, there were few changes in the last years and the approach remains predominantly extrapolated of studies with the adult population.