THE ROLE OF DRUG-TREATMENT IN VARICEAL BLEEDING

Pharmacological management of acute variceal hemorrhage appears to be effective in patients with liver cirrhosis. Somatostatin and presumabl y its longer-acting analog, octreotide, are more efficient and safer t han other vasoconstrictors like vasopressin, terlipressin or their com bination with nitroglycerin. Drug treatment, however, usually represen ts only a valuable adjunct to other measures to stop bleeding such as endoscopic variceal sclerotherapy. Prophylaxis of first bleeding by be ta-blockade appears justified in patients at a high risk of bleeding w hich still has to be defined more precisely. Prevention of recurrent h emorrhage can be effective in some but not in all of the patients with liver cirrhosis and a first bleeding episode. Treatment of patients w ith good liver function under direct control of the wedged hepatic vei n pressure gradient presumably will reduce the failure rate of prophyl axis with beta-blockade.