Pharmacologic therapy for gastrointestinal bleeding due to portal hypertension and esophageal varices.
Cirrhosis results in portal hypertension in many patients. The major complications of portal hypertension include development of ascites and esophageal or gastric varices. Varices lead to hemorrhage and death in a significant proportion of patients. This review focuses on the pharmacologic approach to management of portal hypertension in patients at risk of variceal hemorrhage, or those who have already had variceal bleeding. Pharmacologic therapy is used for 1) primary prevention of bleeding, 2) management of acute bleeding, and 3) prevention of recurrent bleeding (secondary prophylaxis). For acute esophageal variceal hemorrhage, a variety of pharmacologic agents are used, including somatostatin, octreotide, vapreotide, lanreotide, terlipressin, and vasopressin (with nitrates). For primary and secondary prevention of esophageal variceal hemorrhage, beta-blockers remain the mainstay therapy.
Rockey
Don C
DC
Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8887, USA. don.rockey@usouthwestern.edu
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004932:Esophageal and Gastric Varices / Q000209:etiology*; D004945:Esophagoscopy; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications; D009566:Nitrates / Q000627:therapeutic use; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012008:Recurrence; D015911:Sclerotherapy; D013004:Somatostatin / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D006490:Hemostatics; D009566:Nitrates; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D013004:Somatostatin