last updated 20-12-2024

Treatment of oesophageal varices

Treatment of oesophageal varices and portal hypertension

Therapy for variceal bleeding can be divided into the treatment of acute variceal bleeding and the prevention of recurrent bleeding.

Acute treatment requires restoration of the systemic circulation (if impaired), use of drugs that reduce variceal pressure and flow, and/or endoscopic sclerotherapy. Terlipressin causes vasocontriction of the digestive tract vasculature. Somatostatin and octreotide decrease GI motility and blood flow. Both drugs also inhibit secretion of digestive enzymes.

The second aim of preventing recurrent bleeding can be obtained by repeated endoscopic sclerotherapy or band ligation and/or the treatment with ß-blockers. In case of varices and portal hypertension, propranolol is administered as a retard capsule to reduce portal vein pressure. The response to β-blockers is variable and should be monitored based on a reduction in heart-rate by 25%. Primary prevention of variceal bleeding is sometimes prescribed in high-risk patients (based on endoscopic signs).

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Somatostatin and octreotide are effective in acute variceal bleeding because of 

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