Acute variceal bleeding: pharmacological treatment and primary/secondary prophylaxis.
Variceal bleeding is one of the most severe complications of portal hypertension related to liver cirrhosis. Primary prophylaxis is considered mandatory in patients with cirrhosis and high-risk oesophageal varices, and once varices have bled, every effort should be made to arrest the haemorrhage and prevent further bleeding episodes. In acute variceal bleeding, vasoactive drugs that lower portal pressure should be started even before endoscopy, and should be maintained for up to 5 days. The choice of vasoactive drug should be made according to local resources. Terlipressin, somatostatin and octreotide can be used; vasopressin plus transdermal nitroglycerin may be used if no other drug is available. In variceal bleeding, antibiotic therapy is also mandatory. In primary and secondary prophylaxis, beta-blockers are the mainstay of therapy. In secondary prophylaxis (but not in primary prophylaxis) these drugs can be combined with organic nitrates.
Dell'Era
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A
Department of Medical Sciences, University of Milano, and Gastroenterology 3 Unit, IRCCS Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena Foundation, Via Pace 9, 20122 Milano, Italy.
de Franchis
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R
Iannuzzi
F
F
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D004359:Drug Therapy, Combination; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008103:Liver Cirrhosis / Q000150:complications; D008236:Lypressin / Q000031:analogs & derivatives / Q000627:therapeutic use; D015282:Octreotide / Q000627:therapeutic use; D013004:Somatostatin / Q000627:therapeutic use; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D008236:Lypressin; D013004:Somatostatin; D000077585:Terlipressin; D015282:Octreotide