Gastrointestinal bleeding due to ruptured oesophageal varices is one of the most severe complications of portal hypertension, which occurs in up to 30% of patients with varices during the course of their life, with an estimated mortality of 50-80%, although recent studies show a reduction of this rate to 20-30%. After the first hemorrhagic event, rebleeding occurs in about 60% of patient within 1-2 years. Therapy of portal hypertension has evolved along three directions: prevention of the first hemorrhage, management of acute bleeding and prevention of rebleeding. Pharmacologic and endoscopic therapy are the most important non-surgical techniques in the treatment of portal hypertension. In addition balloon tamponade (Sengstaken- Blakemore or Linton tube) can be used in special circumstances. Recently a new interventional radiologic technique called TIPS (Transjugular Intrahepatic Portosystemic Shunt) has been introduced and is currently under evaluation. The pharmacological treatment of portal hypertension aimes at decreasing portal pressure and splanchnic inflow; for the control of acute variceal hemorrhage drugs as vasopressin and somatostatin or their long- acting analogues (octreotide and terlipressin) can be used. In the prevention of the first and further bleeding the most effective drugs are non selective betablockers (nitrates as isosorbide 5 mono o dinitrate have been proposed in patients with contraindications to Beta-blockers). Endoscopic techniques that can be used in patients with portal hypertension are injection sclerotherapy and banding ligation. These techniques can be used either in active bleeding or in prevention of recurrent hemorrages, while, at the moment, there is no indications for their use in primary prophylaxis.
|Translated title of the contribution||Therapy of portal hypertension|
|Number of pages||12|
|Publication status||Published - 1997|
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