Variceal bleeding : pharmacological treatment and prophylactic strategies.

作者: Cándid Villanueva , Joaquim Balanzó

DOI: 10.2165/0003495-200868160-00004

关键词:

摘要: Oesophageal varices and ascites may develop when the hepatic venous pressure gradient (HVPG) increases above 10 mmHg, variceal bleeding occur HVPG rises 12 mmHg. Pharmacological therapy of portal hypertension prevent by reducing below Even if this threshold level is not reached, risk decreases markedly with reductions in that are >20% from baseline.Endoscopic a local treatment prevents obliterating varices, has no effect on pathophysiological mechanisms lead to rupture. When used together, both pharmacological endoscopic therapies have an additive effect, which been demonstrated different clinical settings. In acute oesophageal bleeding, vasoactive drugs (either terlipressin or somatostatin) should be started as soon possible (before diagnostic endoscopy) maintained for 2-5 days. The efficacy pharmacotherapy improved addition emergency therapy. Adding ligation (EVL) improves safety achieved combination sclerotherapy drugs. Antibacterial prophylaxis integral part bleeding.To rebleeding, EVL beta-adrenoceptor antagonists (beta-blockers) isosorbide mononitrate (ISMN) valid first-line choice. beta-blockers alone. Haemodynamic responders without ISMN (i.e. those decrease 20% baseline) reduction haemorrhage 10% patients and, consequently, will need further treatment, while rescue provided nonresponders. Transjugular intrahepatic portosystemic shunts recommended and/or fail. beta-Blockers significantly reduce first large improve survival. Compared beta-blockers, reduces any differences mortality offered who contraindications intolerance beta-blockers.

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