Document Detail


Review article: a critical comparison of drug therapies in currently used therapeutic strategies for variceal haemorrhage.
MedLine Citation:
PMID:  15335394     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Vasoactive drugs are safe and easy to administer, and universal treatment is the first-line approach for all patients with suspected variceal bleeding. There are strong arguments that the combination of vasoactive drugs, started as soon as possible, and endotherapy later on is the best therapeutic option, particularly in cases of ongoing bleeding at the time of endoscopy. The main action of vasoactive drugs is to reduce variceal pressure. This can be achieved by diminishing the variceal blood flow and/or by increasing resistance to variceal blood flow inside the varices. Changes in variceal pressure parallel changes in portal pressure. Drugs for the treatment of variceal bleeding can therefore be assessed by measuring the changes in portal pressure, azygos blood flow and variceal pressure. Vasoactive drugs can be divided into two categories: terlipressin (Glypressin), and somatostatin and its analogues, especially octreotide. Terlipressin significantly reduces portal and variceal pressure and azygos flow, is superior to placebo in the control of variceal haemorrhage and improves mortality. It is beneficial when combined with sclerotherapy. It also has the advantage that it might preserve renal function, one of the most important factors affecting the outcome of cirrhosis. As such, terlipressin is the most potent of the various vasoactive drugs. Somatostatin significantly reduces portal and variceal pressure and azygos flow, is superior to placebo in controlling variceal haemorrhage, and improves the success of sclerotherapy. The effect of octreotide is well established for preventing the increase in portal pressure after a meal (similar to blood in the intestines) though the effect of ocreotide on variceal pressure is controversial.
Authors:
F Nevens
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Alimentary pharmacology & therapeutics     Volume:  20 Suppl 3     ISSN:  0269-2813     ISO Abbreviation:  Aliment. Pharmacol. Ther.     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-08-31     Completed Date:  2004-12-17     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  8707234     Medline TA:  Aliment Pharmacol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  18-22; discussion 23     Citation Subset:  IM    
Affiliation:
Department of Liver and Pancreatic Disease, UZ Gasthuisberg, KU Leuven, Belgium. frederik.nevens@uz.leuven.ac.be
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MeSH Terms
Descriptor/Qualifier:
Esophageal and Gastric Varices / drug therapy*
Gastrointestinal Agents / therapeutic use
Gastrointestinal Hemorrhage / drug therapy*
Humans
Lypressin / analogs & derivatives*,  therapeutic use
Octreotide / therapeutic use
Somatostatin / therapeutic use
Vasoconstrictor Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Gastrointestinal Agents; 0/Vasoconstrictor Agents; 14636-12-5/terlipressin; 50-57-7/Lypressin; 51110-01-1/Somatostatin; 83150-76-9/Octreotide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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