Esophageal varices.
Numerous conditions lead to portal hypertension with the development of esophageal varices. Treatment for acute variceal hemorrhage should progress in a logical, stepwise fashion. Therapy after fluid resuscitation includes vasopressin, somatostatin, or a Sengstaken-Blakemore tube. This is followed by treatment with sclerotherapy, variceal ligation, or a combination of both. Continued bleeding is managed by more invasive measures that include radiologic embolization or shunting, esophageal transection, distal splenorenal shunt, or liver transplantation. Beta-blockade may be useful to prevent recurrent bleeding in compliant patients without medical conditions that would preclude use of beta-blockade. Once control of the bleeding has been achieved, sclerotherapy or ligation should be used to obliterate the varices, but prophylactic use of sclerosant is not particularly beneficial.
Goff
J S
JS
University of Colorado Health Sciences Center, Denver.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D004945:Esophagoscopy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods; D008026:Ligation / Q000379:methods; D016031:Liver Transplantation; D011170:Portasystemic Shunt, Surgical / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D015911:Sclerotherapy / Q000379:methods; D013004:Somatostatin / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D014667:Vasopressins; D013004:Somatostatin