Acute variceal bleeding: Pharmacological treatment and primary/secondary prophylaxis

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Acute variceal bleeding: Pharmacological treatment and primary/secondary

prophylaxis

A. Dell'Era MD, Assistant Professor of Medicine (Gastroenterology), R. de

Franchis MD, , Professor of Medicine, Director (Gastroenterology) and F.

Iannuzzi MDa, GI Fellow

aDepartment 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

Available online 15 March 2008.

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.

Key words: liver cirrhosis; therapy; prophylaxis; variceal bleeding

Corresponding author. Tel.: +39 02 5503 5331/2; Fax: +39 02 5032 0747.

Best Practice & Research Clinical Gastroenterology

Volume 22, Issue 2, April 2008, Pages 279-294

Upper and Lower Intestinal Tract Bleeding

http://www.sciencedirect.com/science?_ob=ArticleURL & _udi=B6WBF-4S2GHP4-8 & _user=1\

0 & _coverDate=04%2F30%2F2008 & _rdoc=8 & _fmt=summary & _orig=browse & _srch=doc-info(%23\

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e9777d3f0efe891ef3bdc35d6e5f268

_________________________________________________________________

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[Guest guest]

Acute variceal bleeding: Pharmacological treatment and primary/secondary

prophylaxis

A. Dell'Era MD, Assistant Professor of Medicine (Gastroenterology), R. de

Franchis MD, , Professor of Medicine, Director (Gastroenterology) and F.

Iannuzzi MDa, GI Fellow

aDepartment 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

Available online 15 March 2008.

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.

Key words: liver cirrhosis; therapy; prophylaxis; variceal bleeding

Corresponding author. Tel.: +39 02 5503 5331/2; Fax: +39 02 5032 0747.

Best Practice & Research Clinical Gastroenterology

Volume 22, Issue 2, April 2008, Pages 279-294

Upper and Lower Intestinal Tract Bleeding

http://www.sciencedirect.com/science?_ob=ArticleURL & _udi=B6WBF-4S2GHP4-8 & _user=1\

0 & _coverDate=04%2F30%2F2008 & _rdoc=8 & _fmt=summary & _orig=browse & _srch=doc-info(%23\

toc%236709%232008%23999779997%23683340%23FLA%23display%23Volume) & _cdi=6709 & _sort\

=d & _docanchor= & _ct=14 & _acct=C000050221 & _version=1 & _urlVersion=0 & _userid=10 & md5=4\

e9777d3f0efe891ef3bdc35d6e5f268

_________________________________________________________________

How well do you know your celebrity gossip?

http://originals.msn.com/thebigdebate?ocid=T002MSN03N0707A