Role of vasoactive drugs in the treatment of bleeding oesophageal varices

Recent advances in the knowledge of the pathophysiology of portal hypertens ion has opened new indications for the pharmacologic treatment of acute var iceal bleeding. Treatment with vasoactive agents is immediately available, easy to use and can be considered as definitive or adjunctive to endoscopic therapy. The data from randomised trials of vasoactive drug treatment for acute variceal bleeding are reviewed, using meta-analysis where applicable. The use of vasopressin has been decreased as a consequence of its question able efficacy and its high incidence of side effects. Terlipressin is the o nly drug that has been shown to improve survival, albeit in small trials an d there are insufficient data of its use over 5 days. Somatostatin has been shown to have similar efficacy with terlipressin with significantly less s ide effects. The demonstrated efficacy of octreotide in acute variceal blee ding is less than terlipressin and somatostatin and it cannot be considered as drug of fi rst choice. Somatostatin combined with sclerotherapy represe nts the optimal therapy today as this combination has been shown to be more effective than sclerotherapy alone and it is safe given over 5 days. Copyr ight (C) 1999 S. Karger AG, Basel.