, Volume 57, Issue 3, pp 327–335 | Cite as

A Practical Guide to the Management of Oesophageal Varices

  • Geraldine McCormack
  • P. Aiden McCormick
Disease Management


Bleeding oesophageal varices are a frequent and sometimes fatal complication of portal hypertension. Prompt resuscitation and arrest of haemorrhage are the immediate short term priorities. Vasoactive therapy to reduce portal pressure is administered on presentation. Early endoscopy is necessary to make a definitive diagnosis and initiate appropriate therapy; usually emergency sclerotherapy or banding. After the acute bleeding episode, follow-up therapy is instituted either to obliterate the varices by sclerotherapy or banding, or to chronically lower portal pressure and hence reduce the risk of bleeding pharmacologically; a combination of both strategies may be also used. Active surveillance of those at risk of developing varices is advocated. Long term β-blocker therapy has been demonstrated to be effective in both the primary prevention of variceal haemorrhage and the prevention of rebleeding in those who have already bled. Despite a multitude of therapeutic regimes and ongoing clinical trials, mortality from this condition remains disappointingly high.


Adis International Limited Octreotide Portal Hypertension Esophageal Varix Variceal Haemorrhage 
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  1. 1.
    D’Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: a meta-analytic review. Hepatology 1995; 22(1): 332–54PubMedGoogle Scholar
  2. 2.
    Beppu K, Inokuchi K, Koyanagi N, et al. Prediction of variceal haemorrhage by esophageal endoscopy. Gastrointest Endosc 1981; 27: 213–8PubMedCrossRefGoogle Scholar
  3. 3.
    North Italian Endoscopic club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. N Engl J Med 1988; 319: 983–9CrossRefGoogle Scholar
  4. 4.
    Bosch J, Groszman RJ, Garcia-Pagan J, et al. Association of transdermal nitroglycerin to vasopressin infusion in the treatment of variceal haemorrhage: a placebo-controlled clinical trial. Hepatology 1989; 10(6): 962–8PubMedCrossRefGoogle Scholar
  5. 5.
    Burroughs AK, Panagou E. Pharmacological therapy for portal hypertension: rationale and results. Semin Gastrointest Dis 1995; 6(3): 148–64PubMedGoogle Scholar
  6. 6.
    Levacher S, Letoumelin P, Pateron D, et al. Early administration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients. Lancet 1995; 346: 865–8PubMedCrossRefGoogle Scholar
  7. 7.
    Burroughs AK, McCormick PA, Hughes MD, et al. Randomized, double-blind, placebo-controlled trial of somatostatin for variceal rebleeding. Gastroenterology 1990; 99: 1388–95PubMedGoogle Scholar
  8. 8.
    Valenzuela JE, Schubert T, Fogel MR, et al. A multicenter, randomized, double-blind trial of somatostatin in the management of acute haemorrhage from esophageal varices. Hepatology 1989; 10(6): 958–61PubMedCrossRefGoogle Scholar
  9. 9.
    Sung JJY, Chung SCS, Lai CW, et al. Octreotide infusion or emergency sclerotherapy for variceal haemorrhage. Lancet 1993; 342: 637–41PubMedCrossRefGoogle Scholar
  10. 10.
    Jenkins SA, Shields M, Elias E, et al. A multicentre randomised trial comparing octreotide and injection sclerotherapy in the management and outcome of acute variceal haemorrhage. Gut 1997; 41: 526–33PubMedCrossRefGoogle Scholar
  11. 11.
    Besson I, Ingrand I, Person B, et al. Sclerotherapy with or without octreotide for acute variceal bleeding. N Engl J Med 1995; 333: 555–60PubMedCrossRefGoogle Scholar
  12. 12.
    Avgerinos A, Nevens F, Raptis S, et al. Early administration of somatostatin and efficacy of sclerotherapy in acute oesophageal variceal bleeds: the European Acute Bleeding Oesophageal Variceal Episodes (ABOVE) randomised trial. Lancet 1997; 350: 1495–1500PubMedCrossRefGoogle Scholar
  13. 13.
    Poison RJ, Westaby D, Gimson AES, et al. Sucralfate for the prevention of early rebleeding following injection sclerotherapy for esophageal varices. Hepatology 1989; 10(3): 279–82CrossRefGoogle Scholar
  14. 14.
    Paquet KJ, Koussouris P, Keinath R, et al. A comparison of sucralfate with placebo in the treatment of esophageal ulcers following therapeutic endoscopic sclerotherapy of esophageal varices: a prospective controlled randomized trial. Am J Med 1991; 91: 147S–50SPubMedCrossRefGoogle Scholar
  15. 15.
    Garg PK, Sidhu SS, Bhargava DK. Role of omeprazole in prevention and treatment of postendoscopic variceal sclerotherapy esophageal complications. Dig Dis Sci 1995; 40(7): 1569–74PubMedCrossRefGoogle Scholar
  16. 16.
    Gimson A, Poison R, Westaby D, et al. Omeprazole in the management of intractable esophageal ulceration following injection sclerotherapy. Gastroenterology 1990; 99: 1829–31PubMedGoogle Scholar
  17. 17.
    Blaise M, Pateron D, Trinchet J, et al. Systemic antibiotic therapy prevents bacterial infection in cirrhotic patients with gastrointestinal hemorrhage. Hepatology 1994; 20(1): 34–8PubMedCrossRefGoogle Scholar
  18. 18.
    Bornman PC, Krige JEJ, Tereblanche J. Management of oesophageal varices. Lancet 1994; 343: 1079–83PubMedCrossRefGoogle Scholar
  19. 19.
    Williams SGJ, Westaby D. Recent advances in the endoscopic management of variceal bleeding. Gut 1995; 36: 647–8PubMedCrossRefGoogle Scholar
  20. 20.
    Lo GH, Lai KH, Cheng JS, et al. Emergency banding ligation versus sclerotherapy for the control of active bleeding from esophageal varices. Hepatology 1997; 25(5): 1101–4PubMedCrossRefGoogle Scholar
  21. 21.
    Terblanche J, Bornman PC, Kahn D, et al. Failure of repeated injection sclerotherapy to improve long-term survival after oesophageal bleeding. Lancet 1983; 2: 1328–32PubMedCrossRefGoogle Scholar
  22. 22.
    Gimson AES, Ramage JK, Panos MZ, et al. Randomised trial of variceal banding ligation versus injection sclerotherapy for bleeding oesophageal varices. Lancet 1993; 342: 391–4PubMedCrossRefGoogle Scholar
  23. 23.
    Lo GH, Lai KH, Cheng JS, et al. A prospective, randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices. Hepatology 1995; 22(2): 466–71PubMedCrossRefGoogle Scholar
  24. 24.
    Lebrec D, Nouel O, Corbie M, et al. Propranolol-A medical treatment for portal hypertension. Lancet 1980; II: 180–2CrossRefGoogle Scholar
  25. 25.
    Feu F, Garcia-Pagan JC, Bosch J, et al. Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal hemorrhage in patients with cirrhosis. Lancet 1995: 346: 1056–9PubMedCrossRefGoogle Scholar
  26. 26.
    Poynard T, Cales P, Pasta L, et al. Beta-adrenergic antagonist drugs in the prevention of gastrointestinal bleeding in patients with cirrhosis and esophageal varices. N Engl J Med 1991; 324(22): 1532–8PubMedCrossRefGoogle Scholar
  27. 27.
    Reichen J. Liver function and pharmacological considerations in pathogenesis and treatment of portal hypertension. Hepatology 1990; 11(6): 1066–78PubMedCrossRefGoogle Scholar
  28. 28.
    Elsayed SS, Shiha G, Hamid M, et al. Sclerotherapy versus sclerotherapy and propranolol in the prevention of rebleeding from oesophageal varices: a randomised study. Gut 1996; 38: 770–4PubMedCrossRefGoogle Scholar
  29. 29.
    Hayes P, Davis JM, Lewis JA, et al. Meta-analysis of value of propranolol in prevention of variceal haemorrhage. Lancet 1990; 336: 153–6PubMedCrossRefGoogle Scholar
  30. 30.
    Villaneuva C, Balanzo J, Novella MT, et al. Nadolol plus isosorbide mononitrate compared with sclerotherapy for the prevention of variceal rebleeding. N Engl J Med 1996; 334(25): 1624–9CrossRefGoogle Scholar
  31. 31.
    McCormick PA, Dick R, Burroughs AK. The transjugular portosystemic shunt (TIPS) in the treatment of portal hypertension. Aliment Pharmacol Ther 1994; 8(3): 273–82PubMedCrossRefGoogle Scholar
  32. 32.
    McCormick PA, Dick R, Panagou EB, et al. Emergency transjugular intrahepatic stent shunting as salvage treatment for uncontrolled variceal bleeding. Br J Surg 1994; 81: 1324–7PubMedCrossRefGoogle Scholar
  33. 33.
    McCormick PA, Kaye G, Greenslade L, et al. Esophageal staple transection as a salvage procedure after failure of acute injection sclerotherapy. Hepatology 1992; 5(3): 403–6CrossRefGoogle Scholar
  34. 34.
    Greig JD, Garden OJ, Carter DC. Prophylactic treatment of patients with esophageal varices: is it ever indicated? World J Surg 1994; 18: 176–84PubMedCrossRefGoogle Scholar
  35. 35.
    Veterans Affairs Cooperative Variceal Sclerotherapy Group. Prophylactic sclerotherapy for esophageal varices in men with alcoholic liver disease. N Engl J Med 1991; 324(25): 1779–84CrossRefGoogle Scholar
  36. 36.
    Teran JC, Imperiale TF, Mullen KD, et al. Primary prophylaxis of variceal bleeding in cirrhosis: a cost-effectiveness analysis. Gastroenterology 1997; 112: 473–82PubMedCrossRefGoogle Scholar
  37. 37.
    Perez-Ayuso RM, Pique JM, Bosch J, et al. Propranolol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis. Lancet 1991; 337: 1431–4PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1999

Authors and Affiliations

  1. 1.The National Liver UnitSt Vincent’s HospitalDublin 4Ireland

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