Système gastro-intestinal et digestif

Abstrait

Pathophysiology and management of ?Esophageal varices? in current practice

Balwant Singh Gill

Esophageal Varices: Esophageal varices are dilated sub mucosal distal esophageal veins connecting the portal and systemic circulations. This happens due to portal hypertension (most commonly a result of cirrhosis), resistance to portal blood flow, and increased portal venous blood inflow. Bleeding Esophageal Varices: No single treatment for bleeding esophageal varices is appropriate for all patients and situations. An algorithm for management of the patient with acute bleeding is presented in this article. The options for long-term, definitive therapy and the criteria for selection of each are discussed. Pathophysiology and Management of Esophageal Varices: Esophageal varices are one of the most common and severe complications of chronic liver diseases. New aspects in epidemiology, pathogenesis, and treatment of varices are reviewed. Sclerotherapy is the first-line treatment for acute haemorrhage. Prevention of first or recurrent bleeding is still unsatisfactory. β-Blockers are slightly superior to sclerotherapy with regard to prophylaxis of first bleeding. β-Blockers or sclerotherapy may be used for prophylaxis of recurrent bleeding. Endoscopic Therapy for Esophageal Varices: Among therapeutic endoscopic options for esophageal varices (EV), endoscopic variceal ligation (EVL) has proven more effectiveness and safety compared with endoscopic sclerotherapy and is currently considered as the first choice. In acute EV bleeding, vasoactive therapy (either with terlipressin or somatostatin) prior to endoscopy improves outcomes; moreover, antibiotic prophylaxis has to be generally adopted. Conclusion: Compared with untreated controls, prophylactic ligation reduces the risks of variceal bleeding and mortality. Compared with β‐blockers, ligation reduces the risk for first variceal bleed but has no effect on mortality.