Search results
Results from the WOW.Com Content Network
The first is the use of beta-blockers, which reduce portal pressures. Non-selective beta blockers (such as propranolol and nadolol) have been used to decrease the pressure of the portal vein in patients with esophageal varices, and have been shown to regress portal hypertensive gastropathy that has been worsened by medical treatment of varices. [5]
However, non-selective β-blockers do not prevent the formation of esophageal varices. [8] When medical contraindications to beta-blockers exist, such as significant reactive airway disease, then treatment with prophylactic endoscopic variceal ligation is often performed. [9]
Additionally, beta blockers find applications in vascular surgery, the treatment of anxiety states, cases of thyrotoxicosis, glaucoma, migraines, and esophageal varices. [ 13 ]
This is in addition to endoscopic banding or sclerotherapy for the varices. [13] If this is sufficient then beta blockers and nitrates may be used for the prevention of re-bleeding. [13] If bleeding continues, balloon tamponade with a Sengstaken-Blakemore tube or Minnesota tube may be used in an attempt to mechanically compress the varices. [13]
The Sugiura procedure was originally developed to treat bleeding esophageal varices and consisted mainly of an esophagogastric devascularization. It was developed in Japan in 1973 [ 1 ] as a nonshunting technique that achieved variceal bleeding hemostasis by interrupting the variceal blood flow along the gastroesophageal junction.
TIPS is a life-saving procedure in bleeding from esophageal or gastric varices. A randomized study showed that the survival is better if the procedure is done within 72 hours after bleeding. [2] TIPS has shown some promise for people with hepatorenal syndrome. [3] It may also help with ascites. [4]
Portal hypertension is defined as increased portal venous pressure, with a hepatic venous pressure gradient greater than 5 mmHg. [3] [4] Normal portal pressure is 1–4 mmHg; clinically insignificant portal hypertension is present at portal pressures 5–9 mmHg; clinically significant portal hypertension is present at portal pressures greater than 10 mmHg. [5]
Carvedilol is a nonselective beta blocker and alpha-1 blocker. [5] How it improves outcomes is not entirely clear but may involve dilation of blood vessels. [5] Carvedilol was patented in 1978 and approved for medical use in the United States in 1995. [5] [8] It is on the World Health Organization's List of Essential Medicines. [9]