Medical management of variceal hemorrhage.
Gastroesophageal variceal hemorrhage is a major complication of portal hypertension in 50% to 60% of patients with liver cirrhosis and is a frequent cause of mortality in these patients. The prevalence of variceal hemorrhage is approximately 5% to 15% yearly, and early variceal rebleeding has a rate of occurrence of 30% to 40% within the first 6 weeks. More than 50% of patients who survive after the first bleeding episode will experience recurrent bleeding within 1 year. Management of gastroesophageal varices should include prevention of initial and recurrent bleeding episodes and control of active hemorrhage. Therapies used in the management of gastroesophageal variceal hemorrhage may include pharmacologic therapy (vasoactive agents, nonselective b-blockers, and antibiotic prophylaxis), endoscopic therapy, transjugular intrahepatic portosystemic shunt, and shunt surgery. This article focuses primarily on pharmacologic management of acute variceal hemorrhage.
Cat
Tram B
TB
Critical Care, Department of Pharmacy, Antelope Valley Hospital, 1600 West Avenue, Lancaster, CA 93534, USA. tram.cat@avhospital.org
Liu-DeRyke
Xi
X
D058625:End Stage Liver Disease / Q000150:complications; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000401:mortality; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D015282:Octreotide / Q000008:administration & dosage; D011322:Primary Prevention; D011379:Prognosis; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D015911:Sclerotherapy; D012720:Severity of Illness Index; D014662:Vasoconstrictor Agents / Q000494:pharmacology / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use
D005765:Gastrointestinal Agents; D054328:Proton Pump Inhibitors; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D015282:Octreotide