Management of portal hypertension after variceal hemorrhage

Clin Liver Dis. 2001 Aug;5(3):677-707, ix. doi: 10.1016/s1089-3261(05)70188-4.

Abstract

Each variceal bleed is associated with 20% to 30% risk of dying. Management of portal hypertension after a bleed consists of (1) control of bleeding and (2) prevention of rebleeding. Effective control of bleeding can be achieved either pharmacologically by administering somatostatin or octreotide or endoscopically via sclerotherapy or variceal band ligation. In practice, both pharmacologic and endoscopic therapy are used concomitantly. Rebleeding can be prevented by endoscopic obliteration of varices. In this setting, variceal ligation is the preferred endoscopic modality. B-blockade is as effective as endoscopic therapy and, in combination, the two modalities may be additive.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Catheterization
  • Endoscopy
  • Hemodynamics
  • Hemorrhage / etiology*
  • Hemorrhage / physiopathology
  • Hemorrhage / prevention & control
  • Hemorrhage / therapy
  • Humans
  • Hypertension, Portal / complications*
  • Hypertension, Portal / therapy*
  • Ligation
  • Nitrates / therapeutic use
  • Sclerotherapy
  • Varicose Veins / etiology*
  • Vasodilator Agents / therapeutic use

Substances

  • Adrenergic beta-Antagonists
  • Nitrates
  • Vasodilator Agents