Brief Overview about Esophageal varices Management and Prevention

Abstract

Background:Esophageal varices (EV) are the major complication of portal hypertension. It is detected in about 50% of cirrhotic patients, and approximately 5–15% of cirrhotic patients show newly formed varices or worsening of varices every year. It is a hemodynamic abnormality characterized by sudden bleeding episode, about a third of all patients with esophageal varices show bleeding episode.Inspite that both injection sclerotherapy and variceal band ligation are effective in controlling the acute variceal bleeding, band ligation is better for the initial control of bleeding and is accompanied with less side effects and improved mortality.Prevention of complications should run simultaneously to haemostatic therapies from admission of patients with cirrhosis and acute GI bleeding. The main complications, whatever the cause of bleeding, include bacterial infections (such as aspiration pneumonia or spontaneous bacterial peritonitis( SBP) ), hepatic encephalopathy and deterioration of renal function. Bacterial infections are observed in more than50% of patients and may already be present at the time of bleeding (20%) acting as a precipitating event.Early TIPSS (before onset of treatment failure) within 72 hours of admission is associated with significantly lower mortality and treatment failureShunt surgery reserved mainly for Child-Pugh A patients who has been shown to be an effective option as salvage treatment for patients where there is failure to control bleeding with VBL and vasopressors.