ABSTRACT
Haemorrhage from oesophageal varices usually presents as haematemesis or melaena, when bleeding is substantial and dramatic. Presentation as iron-deficiency anaemia is very rare, and other gastrointestinal sources of blood should be excluded. The initial examination must seek evidence for chronic liver disease as well as complications of portal hypertension including ascites and encephalopathy. Clinical assessment of volume status during variceal haemorrhage is difficult as patients may have an associated cardiomyopathy, autonomic neuropathy or already be on β-blockers. Gastric varices usually only bleed when they are large, on the greater curve and with high-risk stigmata on them. As vision may be severely limited during acute variceal haemorrhage a dual-channel endoscope has advantages in allowing suction and washing at the same time as endoscopic therapy. Numerous pharmacological therapies have been advocated for the control of acute bleeding as primary haemostasis, in order to make endoscopic therapy easier to perform and to prevent early rebleeding.
