How to prevent rebleeding after surgery for ruptured esophagogastric fundic variceal bleeding?

  A normal vein in the human body is like a tube that carries blood. When a patient with cirrhosis develops a condition such as portal hypertension, the pressure on the veins gradually increases, causing them to slowly deform – the lumen bulges outward, the walls thin, and the entire tube becomes curved. When this happens in the esophagus or fundus, it is called esophagogastric varices.  The biggest danger of esophagogastric fundic varices is the rupture of the veins, which can cause hemorrhage; if the bleeding is not stopped in time, it can even lead to death. Therefore, patients with esophagogastric fundic varices who are at high risk of bleeding or already have bleeding should be treated aggressively. This is because if a patient has bled once in a year, the risk of rebleeding the following year is as high as 60% – 70%.  Some patients have relapses and recurrent bleeding due to high portal vein pressure and poor results after medication or endoscopic treatment, then this situation should be treated by considering portal odd vein dissection, portal shunt or even liver transplantation. The most commonly used procedure is portal vein dissection, but the dissection procedure only relieves the bleeding from the veins and does not address the root cause – cirrhosis. Therefore, after surgery, patients are prone to relapse of the disease. Roughly 6 percent of patients will bleed again within five years of surgery, and the incidence of rebleeding reaches 13 percent within 10 years.  So in order to prevent re-bleeding, what do patients need to pay attention to?  1. Regular review is important.  Generally, it should be reviewed once in three to six months, including liver function test, coagulation function test, liver tumor marker test, and imaging test (usually abdominal ultrasound is done first; if suspicious conditions are found, CT, MRI, etc. are also needed). In addition, at least once a year, gastroscopy is repeated to observe the varicose veins in the esophagus and fundus of the stomach through gastroscopy.  2, diet eat “soft” not “hard”.  Diet, try to eat some soft food, such as porridge, noodles, egg custard or very soft rice, etc.. Can not eat hard things, such as fish with thorns, meat with hard bones, nuts snacks, etc.. This is because these hard things can easily scratch the veins in the esophagus and fundus of the stomach and cause bleeding. In addition, the structure of the diet should be light, because greasy food, such as fatty meat, will increase the burden on the liver. So “eaters”, you must control your mouth!  3, must stop drinking!  Patients with esophagogastric varices, their own liver function is not good (cirrhosis), if you drink, it will further aggravate the symptoms of cirrhosis, resulting in the recurrence of esophagogastric varices, or even more serious, so patients must stop drinking!  4, strenuous exercise can not do.  Patients who love sports should pay attention to some intense sports don’t do, such as boxing, playing soccer, running marathon, etc. Because esophagogastric fundic varices are caused by portal hypertension, patients may increase the pressure of portal vessels after strenuous exercise. This can easily cause the condition to recur and lead to hemorrhage.