Variceal Bleeding: Pharmacological Therapy

Abstract

The complications of portal hypertension are totally prevented if hepatic venous pressure gradient is decreased below 12 mm Hg. Besides, if this target is not achieved, a 20% decrease in portal pressure from baseline levels offers an almost total protection from variceal bleeding. This sets the rationale for drug therapy to reduce portal pressure in portal hypertension. Pharmacological therapy to decrease portal pressure includes vasoconstrictors to decrease portal blood inflow, vasodilators to decrease hepatic resistance, and combination therapy. Oral agents, such as b-adrenergic blockers and organic nitrates, are used for long-term prevention of variceal bleeding, while parenteral agents, such as somatostatin (and analogues) and terlipressin, are used for the treatment of acute variceal bleeding.

Effect of heme oxygenase‐1 induction by octreotide on TNBS‐induced colitis

“…Somatostatin receptors are expressed on neurons, inflammatory and vascular endothelial cells, and every neuroendocrine cell in the gastrointestinal‐pancreatic‐hepatobiliary system. Current indications for somatostatin therapy include hormone‐expressing neuroendocrine tumors, intractable diarrhea and variceal bleeding secondary to portal hypertension 13–15,33 …”

The use of somatostatin and octreotide in the treatment of gastrointestinal bleeding

“…Метаанализа ових студија показала је бенефит по питању редукције раног рекрварења, али без утицаја на морталитет (27). Eфекти октреотида приписују се његовој способности да смањи постпрандијални пораст портног притиска (28). У поређењу са другим вазоактивним лековима, октреотид се показао ефикаснијим у поређењу са вазопресином и подједнако ефикасним у поређењу са терлипресином (10).…”

“…Највећи ефекат октреотид је показао када се користио уз ендоскопску терапију. Октеротид се сматра леком другог избора уколико су терлипресин и соматостатин доступни (28).…”

Esophageal Capsule Endoscopy for Screening Esophageal Varices among Japanese Patients with Liver Cirrhosis

“…Esophageal varices (EV) arise when the hepatic-venous pressure gradient reaches >10–12 mmHg [1], and they comprise a serious complication of portal hypertension. The reported incidence of EV ranges between 5% and 12% [2], but about 90% of patients with cirrhosis will develop EV.…”

“…Primary prophylaxis with pharmacological agents or endoscopic treatment has been adopted to reduce mortality associated with variceal bleeding [6–8]. However, treatment with beta blockers and/or endoscopic band ligation is useful for the primary prophylaxis of variceal bleeding only in some patients with high-risk EV [1, 8–10]. Therefore, endoscopic screening is required to detect high-risk EV in patients with liver cirrhosis so that appropriate prophylactic treatment can be initiated [8, 10].…”