Hemorragia digestiva alta varicosa: relatório do 1º consenso da Sociedade Brasileira de Hepatologia

Nas ultimas duas decadas, foi observada reducao importante na mortalidade associada ao primeiro sangramento varicoso, que vem sendo atribuida a melhoria na assistencia ao paciente cirrotico e a abordagem multidisciplinar do paciente com hemorragia digestiva alta varicosa (HDAV), particularmente por emergencistas, hepatologistas, gastroenterologistas, endoscopistas e intensivistas. Visando estabelecer recomendacoes para o manejo da HDAV, a Sociedade Brasileira de Hepatologia (SBH) realizou reuniao de consenso para elaboracao de documento a ser utilizado como orientacao de conduta medica. Dentro da sistematica utilizada, foi criada pela SBH uma comissao organizadora composta por quatro membros que escolheram 27 pesquisadores, representando as diversas regioes do pais, para serem moderadores ou expositores dos topicos relacionados a prevencao, diagnostico e tratamento da HDAV. Todos os topicos foram abordados de acordo com o grau de evidencia cientifica disponivel. As recomendacoes foram elaboradas em reuniao apos ampla discussao com os membros da comissao organizadora, expositores, moderadores e participantes da reuniao do consenso, ficando a cargo da comissao organizadora a redacao do documento final. A reuniao do consenso ocorreu em Salvador em 06 de maio de 2009 e esta publicacao exibe as principais conclusoes do consenso organizadas sob a forma de resumo da literatura medica seguido pelas recomendacoes da SBH. In the last decades, several improvements in the management of variceal bleeding have resulted in a significant decrease in morbidity and mortality of cirrhotis with bleeding varices. Progress in the multidisciplinary approach to the patient with variceal blleding has led to a better management of this disease by critical care physicians, hepatologists, gastroenterologists, endoscopists, radiologists and surgeons. In this respect, the Brazilian Society of Hepatology has, recently, sponsored a consensus meeting in order to draw evidence-based recommendations on the management of these difficult-totreat subjects. An organizing committee comprised of four people was elected by the Governing Board and was responsible to invite 27 researchers from distinct regions of the country to make a systematic review of the subject and to present topics related to variceal bleeding, including prevention, diagnosis, management and treatment, accoding to evidence-based medicine. After the meeting, all participants were held together for discussion of the topics and the elaboration of the aforementioned recommendations. The organizing committee was responsible for writing the final document. The meeting was held at Salvador, May 6th, 2009 and the present manucrispt is the summary of the systematic review that was presented during the meeting organized in topics followed by the reccomendations of the Brazilian Society of Hepatology.