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Treatments and drugs
By Mayo Clinic staffThe primary aim in treating esophageal varices is to prevent bleeding. To help achieve this goal, doctors usually prescribe high blood pressure drugs (beta blockers) to reduce pressure in the portal vein once your initial episode of bleeding has resolved. Other drugs may be used for people who don't respond to beta blockers or who have severe side effects. Sometimes the varices may be injected directly with a solution that causes them to shrink. Or they may be tied with elastic bands before they have a chance to bleed.
Treating bleeding
Bleeding varices are life-threatening, and immediate treatment is essential. To stop bleeding, you're likely to have one of the following procedures:
- Variceal ligation. This is the preferred treatment for bleeding esophageal varices. During the procedure, your doctor uses an endoscope to snare the varices with an elastic band, which essentially "strangles" the veins. Variceal ligation usually causes fewer serious complications than do other treatments. It's also less likely to lead to episodes of repeat bleeding.
- Endoscopic injection therapy. In this procedure, the bleeding varices are injected with a solution that shrinks them. Bleeding is usually controlled after one or two treatments, but complications can occur, including perforation of the esophagus and scarring of the esophagus that can lead to trouble swallowing (dysphagia).
- Medications. A drug called octreotide (Sandostatin, Sandostatin LAR) is often used in combination with endoscopic therapy to treat bleeding from esophageal varices. Octreotide works by reducing pressure in the varices. The drug is usually continued for five days after a bleeding episode.
- Balloon tamponade. This procedure is sometimes used to stop severe bleeding while waiting for a more permanent procedure. A tube is inserted through your nose and into your stomach and then inflated. The pressure against your veins can temporarily stop bleeding.
- Shunt. In this procedure, called transjugular intrahepatic portosystemic shunt (TIPS), a small tube called a shunt is placed between the portal vein and the hepatic vein, which carries blood from your liver back to your heart. The tube is kept open with a metal stent. By providing an artificial path for blood through the liver, the shunt often can control bleeding from esophageal varices. But TIPS can cause a number of serious complications, including liver failure and encephalopathy, which may develop when toxins that would normally be filtered by the liver are passed through the shunt directly into the bloodstream. TIPS is mainly used when all other treatments have failed or as a temporary measure in people awaiting a liver transplant.
- Liver transplant. Because no treatment is entirely successful at preventing repeat bleeding episodes and because treatments themselves pose significant risks, liver transplant is an option for people with severe or recurrent bleeding of esophageal varices. Although liver transplantation is often successful, the number of people awaiting transplants far outnumbers the available organs. You may face additional hurdles if your liver disease is the result of alcoholic hepatitis. Some medical centers won't perform liver transplants on people with alcoholic liver disease or require that you abstain from alcohol for at least six months before you're eligible for transplant surgery.
- Dite P, et al. World Gastroenterology Organisation Practice Guidelines: Esophageal Varices. World Gastroenterology Organisation. http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/18_treatment_e_varices_en.pdf. Accessed Aug. 21, 2008.
- Sanyal, AJ. General principles of the management of variceal hemorrhage. http://www.uptodate.com/home/index.html. Accessed Aug. 21, 2008.
- Runyon, BA. Patient information: Screening for esophageal varices. http://www.uptodate.com/home/index.html. Accessed Aug. 21, 2008.
- Goff JS. Endoscopic variceal ligation. http://www.uptodate.com/home/index.html. Accessed Aug. 21, 2008.
- Portal hypertension. Merck Manuals Online Medical Library. http://www.merck.com/mmhe/print/sec10/ch135/ch135d.html. Accessed Aug. 21, 2008.
- Sanyal, AJ. Prediction of variceal hemorrhage. http://www.uptodate.com/home/index.html. Accessed Aug. 21, 2008.
- Sanyal, AJ. Treatment of active variceal hemorrhage. http://www.uptodate.com/home/index.html. Accessed Aug. 21, 2008.
- Sanyal, AJ. Primary prophylaxis against variceal hemorrhage in patients with cirrhosis. http://www.uptodate.com/home/index.html. Accessed Aug. 21, 2008.
- Sanyal, AJ. Prevention of recurrent variceal hemorrhage in patients with cirrhosis. http://www.uptodate.com/home/index.html. Accessed Aug. 20, 2008.
- Picco MF (expert opinion). Mayo Clinic, Jacksonville, Fla. Aug. 24, 2008.
