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Acute bleeding from oesophageal varices


Authors: P. Drastich
Authors‘ workplace: Klinika hepatogastroenterologie IKEM, Praha, Přednosta: prof. MUDr. Julius Špičák, CSc.
Published in: Prakt. Lék. 2012; 92(9): 494-498
Category: Various Specialization

Overview

Urgent endoscopic sclerotherapy or ligation at the time of initial diagnostic endoscopy, represent the gold standard of care for patients with liver cirrhosis and bleeding esophageal varices following resuscitation measures leading to hemodynamic stability. Terlipressin and somatostatin are vasoactive drugs of choice and they should be given to patients with suspected variceal bleeding before admission or, at the latest, immediately after admission to hospital and prior to endoscopic treatment. Further studies are necessary to evaluate the role of tissue or fibrin glue in patients without adequate answers to the administration of vasoactive drugs and endoscopic therapy. Due to a favorable effect on short-term survival, antibiotic treatment is an integral part of the therapy for bleeding in patients with liver cirrhosis; their administration is initiated immediately after admission to hospital. In the case of uncontrolled bleeding the emergency introduction of TIPS (transjugular intrahepatic portosystemic shunt) using coated metallic stent represent a rescue therapy. We are waiting for results of further randomized controlled studies that will examine the role of metallic esophageal stents compared with standard therapy, especially with ligation and TIPS.

Key words:
acute bleeding from oesophageal varices, portal hypertension, liver cirrhosis.


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