EARLY MANAGEMENT OF BLEEDING OESOPHAGEAL VARICES

摘要

Bleeding from oesophageal varices is a medical emergency with high mortality. In this article, we discuss its early management, focusing on the use of endoscopic therapy and drug treatment. Oesophageal varices are dilated submucosal veins that project into the lumen of the gullet. They form as a result of raised hepatic portal vein pressure (portal hypertension), which commonly occurs in patients with liver cirrhosis, but can arise in any condition where there is a disruption of pre-, intra-or post-hepatic blood flow. Portal hypertension forces anastomoses between the portal and systemic circulation to enlarge; when this occurs at the gastro-oesophageal junction, oesophageal varices are formed. In about a third of patients, the varices eventually burst, leading to gastrointestinal bleeding.