Management of esophageal varices bleeding
Journal Title: Postępy Nauk Medycznych - Year 2014, Vol 27, Issue 1
Abstract
Esophageal variceal bleeding is the most severe complication of portal hypertension. In most cases portal hypertension results from chronic hepatitis of different etiology or is an innate sequela of liver cirrhosis. In the past few decades, six week mortality of the single bleeding episode approached 50%. Nowadays, due to better understanding of pathophysiology that enables tailoring of the treatment, progress both in pharmacotherapy and endoscopy, the mortality rate has decreased below 20%. Still, variceal bleeding poses a great challenge for the medical staff. Accurate diagnosing of patients at risk of developing varices is of great importance, as is the primary prophylaxis. In case of acute bleeding achieving hemostasis and stabilizing the patient at risk substantially improves survival. Managing of a patient with acute variceal esophageal bleeding is based on vigorous but rational fluid balancing, on stabilizing morphology parameters, and confirming esophageal source of bleeding. The cornerstone of the treatment remains the combination of pharmacotherapy with vasoactive agent(s) and endoscopic obliteration of the ruptured varix with banding or sclerotherapy. In case of failure second endoscopic attempt is justified but further options are TIPSS or shunt surgery. After successful hemostasis the secondary prophylaxis is a must determined by 70% annual rate of recurrent bleeding. First episode of variceal bleeding heralds negative change of the natural history of cirrhosis and should encourage to considering liver transplantation in selected cases.
Authors and Affiliations
Włodzimierz Zych, Andrzej Habior
Keywords
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