Bleeding esophagogastric varices. Ways to treat active episodes and prevent recurrence.
Bleeding from esophagogastric varices carries a high mortality rate. Active variceal bleeding can usually be temporarily controlled medically with a combination of intravenous vasopressin and nitroglycerin, with balloon tamponade, or with endoscopic sclerotherapy. Because of the high likelihood of recurrence, long-term treatment, such as repeated sclerotherapy, propranolol therapy, or shunt surgery, is necessary. The proper selection of such measures requires consideration of the site of variceal bleeding, local availability of specialized techniques, and patient factors. Only liver transplantation reverses the liver damage and offers hope of improved long-term survival. As success at identifying high-risk patients by endoscopic features improves, propranolol or other pharmacologic prophylaxis may become an acceptable treatment.
Marshall
J B
JB
Department of Medicine, University of Missouri School of Medicine, Columbia 65212.
D021721:Balloon Occlusion; D002404:Catheterization / Q000379:methods; D002985:Clinical Protocols / Q000592:standards*; D004502:Education, Medical, Continuing; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000150:complications*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D016031:Liver Transplantation; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use; D011433:Propranolol / Q000494:pharmacology / Q000627:therapeutic use; D012008:Recurrence; D015911:Sclerotherapy / Q000379:methods; D013004:Somatostatin / Q000494:pharmacology / Q000627:therapeutic use; D014667:Vasopressins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use
D014667:Vasopressins; D013004:Somatostatin; D011433:Propranolol; D005996:Nitroglycerin