Esofagitis por píldoras / Pill-induced esophageal injury

Si bien no se encuentra entre las principales causas de disfagia u odinofagia, la lesión de la mucosa del esófago a causa de la medicación administrada como píldoras debe ser tenida en cuenta, en particular en algún grupo etario con patologías crónicas. Presentamos el caso de una mujer con dolor retroesternal de confuso diagnóstico y buena evolución con tratamiento conservador. El mecanismo preciso por el cual se producen las lesiones no está bien claro. La videoendoscopia digestiva alta es la herramienta clave para observar las lesiones producidas y realizar diagnóstico diferencial; además puede resolver algunas complicaciones. En la mayoría de los casos, el tratamiento es médico. Esta situación debe tenerse presente para realizar un correcto interrogatorio y examen endoscópico.

Dysphagia and odynophagia should be considered as symptoms of pill-induced esophageal injury, particularly in age groups with chronic diseases. We report a case of a female patient with retrosternal chest pain of unclear diagnosis and favorable outcome with conservative treatment. The precise mechanism of esophageal injury remains uncertain. Upper gastrointestinal videoendoscopy is the essential tool to examine the lesions, make differential diagnosis and treat some complications. Medical treatment is useful in most cases. This condition should be kept in mind for proper interrogation and endoscopic examination.

Efectividad y seguridad de somatostatina comparada con octreotida y terlipresina para el control de la hemorragia de vías digestivas altas en adultos con várices esofágicas / Effectiveness and safety of somatostatin compared to octreotide and terlipressin for the control of upper gastrointestinal tract bleeding in adults with esophageal varices

Antecedentes: Descripción de la condición de salud de interés: La hipertensión portal, es comúnmente causada por la cirrosis hepática, resulta en varios flujos venosos colaterales por los cuales la sangre del sistema porta alcanza la circulación sistémica. De éstos flujos colaterales los que son clínicamente significativos son aquellos que circundan el cardias, donde la vena gástrica izquierda, la vena gástrica posterior y las venas gástricas cortas eventualmente se anastomosan con la vena ácigos menor y con la vena intercostal del sistema venoso sistémico. Esto lleva a la formación de alteraciones en la capa submucosa del tercio inferior del esófago y del fondo del estómago, y se denominan comúnmente várices. La importancia clínica radica en que la ruptura de estas várices resulta en una hemorragia gastroesofágica que es la complicación letal más frecuente de la cirrosis. Descripción de la tecnología: La somatostatina es una hormona del grupo de las hormonas hipofisiarias. La siguiente es la descripción del grupo H "Hormonas sistémicas excluyendo las hormonas sexuales y las insulinas" al cual pertenece. Evaluación de efectividad y seguridad: Pregunta de investigación: La pregunta de investigación fue validada teniendo en cuenta las siguientes fuentes de información: registro sanitario INVIMA, Acuerdo 029 de 2011, guías de práctica clínica, reportes de evaluación de tecnologías, revisiones sistemáticas y narrativas de la literatura, estudios de prevalencia/incidencia y carga de enfermedad, consulta con expertos temáticos, y otros actores clave. \r\nNo se identificaron otros comparadores relevantes para la evaluación. Población: Adultos con hemorragia de vías digestivas altas secundaria a várices esofágicas. Metodología: Búsqueda de literatura, Búsque\r\nda en bases de datos electrónicas. Conclusiones: -Efectividad: somatostatina, octreotide y terlipresina\r\nson efectivas para el tratamiento de pacientes adultos con hemorragia de vías digestivas altas secundaria a várices esofágicas. No hay diferencias estadísticamente significativas entre ellas al evaluar mortalidad, control \r\ndel sangrado y resangrado; -Seguridad: En el estudio incluido no se encontraron datos acerca de la ocurrencia de eventos adversos entre somatostatina y sus comparadores.

The secondary prophylactic efficacy of beta-blocker after endoscopic gastric variceal obturation for first acute episode of gastric variceal bleeding

BACKGROUND/AIMS: The most appropriate treatment for acute gastric variceal bleeding (GVB) is currently endoscopic gastric variceal obturation (GVO) using Histoacryl(R). However, the secondary prophylactic efficacy of beta-blocker (BB) after GVO for the first acute episode of GVB has not yet been established. The secondary prophylactic efficacy of BB after GVO for the first acute episode of GVB was evaluated in this study. METHODS: Ninety-three patients at Soonchunhyang University Hospital with acute GVB who received GVO using Histoacryl(R) were enrolled between June 2001 and March 2010. Among these, 42 patients underwent GVO alone (GVO group) and 51 patients underwent GVO with adjuvant BB therapy (GVO+BB group). This study was intended for patients in whom a desired heart rate was reached. The rates of rebleeding-free survival and overall survival were calculated for the two study groups using Kaplan-Meyer analysis and Cox's proportional-hazards model. RESULTS: The follow-up period after the initial eradication of gastric varices was 18.14+/-25.22 months (mean+/-SD). During the follow-up period, rebleeding occurred in 10 (23.8%) and 21 (41.2%) GVO and GVO+BB patients, respectively, and 39 patients died [23 (54.8%) in the GVO group and 16 (31.4%) in the GVO+BB group]. The mean rebleeding-free survival time did not differ significantly between the GVO and GVO+BB groups (65.40 and 37.40 months, respectively; P=0.774), whereas the mean overall survival time did differ (52.54 and 72.65 months, respectively; P=0.036). CONCLUSIONS: Adjuvant BB therapy after GVO using Histoacryl(R) for the first acute episode of GVB could decrease the mortality rate relative to GVO alone. However, adjuvant BB therapy afforded no benefit for the secondary prevention of rebleeding in GV.

Prospective study of bacteremia rate after elective band ligation and sclerotherapy with cyanoacrylate for esophageal varices in patients with advanced liver disease / Estudo de bacteriemia relacionada à ligadura elástica versus injeção de cianocrilato para varizes esofágicas em pacientes com doença hepática avançada

CONTEXT: Band ligation (BL) is the most appropriate endoscopic treatment for acute bleeding or prophylaxis of esophageal variceal bleeding. Sclerotherapy with N-butyl-2-cyanoacrylate (CY) can be an alternative for patients with advanced liver disease. Bacteremia is an infrequent complication after BL while the bacteremia rate following treatment with CY for esophageal varices remains unknown. OBJECTIVES: To evaluate and compare the incidence of transient bacteremia between cirrhotic patients submitted to diagnostic endoscopy, CY and BL for treatment of esophageal varices. METHODS: A prospective study comprising the period from 2004 to 2007 was conducted at Hospital of Universidade Federal de São Paulo, UNIFESP, SP, Brazil. Cirrhotic patients with advanced liver disease (Child-Pugh B or C) were enrolled. The patients were divided into two groups according treatment: BL Group (patients undergoing band ligation, n = 20) and CY Group (patients receiving cyanoacrylate injection for esophageal variceal, n = 18). Cirrhotic patients with no esophageal varices or without indication for endoscopic treatment were recruited as control (diagnostic group n = 20). Bacteremia was evaluated by blood culture at baseline and 30 minutes after the procedure. RESULTS: After 137 scheduled endoscopic procedures, none of the 58 patients had fever or any sign suggestive of infection. All baseline cultures were negative. No positive cultures were observed after CY or in the control group - diagnostic endoscopy. Three (4.6 percent) positive cultures were found out of the 65 sessions of band ligation (P = 0.187). Two of these samples were positive for coagulase-negative staphylococcus, which could be regarded as a contaminant. The isolated microorganism in the other case was Klebsiella oxytoca. The patient in this case presented no evidence of immunodeficiency except liver disease. CONCLUSIONS: There was no significant difference in bacteremia rate between these three groups. BL or CY injection for non-bleeding esophageal varices may be considered as low-risk procedures regarding bacteremia even when performed on patients with advanced liver disease.

CONTEXTO: A ligadura elástica é considerada o melhor tratamento endoscópico para o sangramento agudo por varizes esofágicas ou para profilaxia do sangramento varicoso, sendo a escleroterapia com N-2-butil-cianoacrilato uma alternativa para os pacientes com doença hepática avançada e distúrbio de coagulação. Bacteriemia é uma complicação rara associada à ligadura elástica, por outro lado, a incidência de bacteriemia relacionada com o uso de N-2-butil-cianoacrilato permanece desconhecida. OBJETIVOS: Avaliar e comparar a incidência de bacteriemia transitória entre os pacientes cirróticos submetidos a endoscopia digestiva alta diagnóstica, escleroterapia com N-2-butil-cianoacrilato ou ligadura elástica para tratamento das varizes esofágicas. MÉTODOS: Estudo prospectivo realizado entre 2004 e 2007 foi conduzido no Hospital da Universidade Federal de São Paulo, UNIFESP, Brasil. Cirróticos com doença hepática avançada (Child B ou C) foram incluídos. Os pacientes foram divididos em dois grupos de acordo com o tratamento: grupo ligadura elástica (pacientes submetidos a ligadura elástica, n = 20) e grupo N-2-butil-cianoacrilato (pacientes submetidos a injeção de N-2-butil-cianoacrilato, n = 18). Cirróticos sem varizes esofágicas ou com varizes esofágicas sem indicação de tratamento endoscópico foram recrutados como controles (grupo endoscopia diagnóstica, n = 20). Bacteriemia foi avaliada por hemocultura basal e 30 minutos após o procedimento. RESULTADOS: Dos 137 procedimentos endoscópicos realizados, nenhum dos 58 pacientes apresentou febre ou qualquer sinal sugestivo de infecção. Todas as hemoculturas de base foram negativas. Nenhuma cultura positiva foi observada após o uso de N-2-butil-cianoacrilato ou no grupo controle. Três (4,6 por cento) culturas positivas foram encontradas após as 65 sessões de ligadura elástica (P = 0,187). Duas dessas foram positivas para Staphylococcus coagulase-negativo, provavelmente relacionadas à contaminação. O microorganismo isolado no terceiro caso foi Klebsiella oxytoca. Nesse caso, o paciente apresentava a própria doença hepática como única situação relacionada à imunodeficiência. CONCLUSÕES: Não houve diferença significante na incidência de bacteriemia entre os três grupos de pacientes. Ligadura elástica ou injeção de N-2-butil-cianoacrilato para profilaxia do sangramento varicoso podem ser considerados procedimentos de baixo risco quanto ao surgimento de bacteriemia, mesmo em pacientes com doença hepática avançada.

Profilaxia secundária endoscópica e medicamentosa em crianças e adolescentes com varizes esofágicas / Endoscopic and pharmacologic secondary prophylaxis in children and adolescents with esophageal varices

Hipertensão porta é uma síndrome clínica decorrente de doenças hepáticas e hepáticas, tendo como principal complicação a hemorragia digestiva alta por sangramento de varizes esofagianas. O objetivo deste artigo é apresentar revisão atualizada sobre profilaxia secundária de varizes esofagianas em crianças e adolescentes, a partir de revisão da literatura dos últimos 30 anos, A profilaxia secundária está indicada a todos os pacientes com sangramento de varizes esofagianas. Em adultos, o método considerado de melhor eficácia é o uso combinado de beta-bloqueador e ligadura elástica. Na infância, não existe consenso sobre a melhor forma de profilaxia e a maioria dos estudos são relatos de séries de casos. A terapia endoscópica tem apresentado eficácia de 80 a 100% em erradicar as varizes esofágicas. O único estudo randomizado em pediatria que comparou os métodos endoscópicos foi mais favorável à ligadura elástica. Poucos estudos relatam o uso do propranolol na infância. Somente um estudo, não randomiza- do, comparou escleroterapia isolada ou associada ao propranolol e não foi observado benefício com a associação. Desta forma, não há consenso sobre a melhor forma de realizar profilaxia secundária na criança. A terapia endoscópica tem se mostrado eficaz em erradicar as varizes esofágicas, porém, o papel do propranolol em pediatria ainda precisa ser definido.

Portal hypertension is a clinical syndrome resulting from hepatic and extra-hepatic diseases. Its main complication is high digestive hemorrhage from esophageal varices bleeding. The aim of this work is to present an updated revision on secondary prophylaxis of esophageal varices bleeding in children and adolescents through a revision of the literature from the past thirty years. The secondary prophylaxis is appropriated to ali the patients with esophageal varices bleeding. In adults, the method of better efficiency is considered to be the combined use of betablockers and endoscopic band ligation. As for childhood, there is not a consensus on the best form of prophylaxis and most of the studies are reports of series of cases. The endoscopic treatment has been presenting efficiency in eradicating from 80 to 100 % of the esophageal varices. The only randomized study in pediatrics that compared the endoscopics methods was more favorable to the endoscopic band ligation. Few studies report the use of propranolol in the childhood. Only one study, not randomized, compared endoscopic sclerotherapy isolated ar associated to propranolol and benefit was not observed with the association. Thus, there is no consensus on the best form of carrying out secondary prophylaxis in the child. The endoscopic therapy has shown itself efficient in eradicating the esophageal varices. The role of propranolol in pediatrics still needs to be defined.

Profilaxis primaria de várices esofágicas en pediatría / Primary prophylactic treatment of esophageal varices in pediatrics

Children with chronic liver disease or portal vein thrombosis frequently develop portal hypertension. The main complication of the portal hypertension are the development of esophageal varices who are at risk of variceal bleeding, which is associated with significant morbidity and mortality. Guidelines for adults with portal hypertension recommend performing esophagogastroduodenoscopy to identify those with varices that may benefit from prophylactic therapy, however there are no consensus in the pediatric age. This revision includes the incidence, diagnostic and the evidence for primary prophylactic treatment of the esophageal varices in children.

Pacientes pediátricos con daño hepático crónico o con trombosis de la vena porta frecuentemente desarrollan hipertensión portal. La principal complicación de la hipertensión portal es el desarrollo de várices esofágicas que conlleva riesgo de hemorragia variceal, la cual se asocia a significativa morbimortalidad. Las guías clínicas para adultos recomiendan realizar, en pacientes cirróticos, una endoscopia como screening para el diagnóstico de várices esofágicas y su tratamiento profiláctico, sin embargo, en pacientes pediátricos no existe consenso. En esta revisión se actualiza la incidencia, diagnóstico y evidencia del tratamiento profiláctico primario de várices esofágicas en pediatría.

Prevention of Esophageal Variceal Bleeding / 대한소화기학회지

Esophageal varices(EV) are present in 40% and 60% of Child-Pugh A and C patients, respectively when cirrhosis is diagnosed. EV bleeding is a life-threatening complication of liver cirrhosis with a high probability of recurrence. Treatment to prevent first EV bleeding or rebleeding is mandatory. In small EV with high risk of bleeding, nonselective beta-blockers should be used for the prevention of first variceal bleeding. For medium to large EV, nonselective beta-blockers or endoscopic variceal ligation (EVL) may be recommended to high risk varices. But, nonselective beta-blockers are the first treatment option to non-high risk varices and EVL is an alternative when nonselective beta-blockers are contraindicated or not tolerated. For the prevention of rebleeding, a combination of nonselective beta-blockers and EVL may be the best option. A great improvement in the prevention of variceal bleeding has emerged over the last years. However, further therapeutic options that combine higher efficacy, better tolerance and fewer side effects are needed.

Comparison of Terlipressin and Octreotide with Variceal Ligation for Controlling Acute Esophageal Variceal Bleeding: a Randomized Prospective Study / 대한간학회지

BACKGROUND/AIMS: Terlipressin and octreotide had been used to control acute variceal bleeding and to prevent early rebleeding after endoscopic hemostasis. We compared the efficacy and safety of terlipressin and octreotide combined with endoscopic variceal ligation (EVL) for the treatment of acute esophageal variceal bleeding and we evaluated their clinical significance as related to rebleeding. METHODS: The eighty eight cirrhotic patients were randomized to the terlipressin group (n=43; 2 mg i.v. initially and 1 mg i.v. at every 4 hours for 3 days) or the octreotide group (n=45; continuous infusion of 25 microgram/h for 5 days) combined with EVL for the treatment of acute esophageal variceal bleeding. RESULTS: The initial hemostasis rates were 98% (42/43 cases) in the terlipressin group and 96% (43/45 cases) in the octreotide group. The 5-day and 42-day rebleeding rates were 12% (5/43 cases) and 28% (12/43 cases), respectively, in the terlipressin group and 9% (4/45 cases) and 24% (11/45 cases), respectively, in the octreotide group. No significant difference was demonstrated between the terlipressin and octreotide groups. The mortality at 42 days was similar in both group, but a high mortality rate (48%) was shown to be related to 42-day rebleeding. The risk factors related to 42-day rebleeding were Child-Pugh class C (aOR=30.2, 95% CI=7.7-117.9), ascites above grade II (aOR=6.6, 95% CI=2.2-19.2) and advanced hepatocellular carcinoma (aOR=4.6, 95% CI=1.1-18.9). CONCLUSIONS: Comparing terlipressin and octreotide combined with EVL showed them to be equally safe and effective therapeutic agents in patients with acute esophageal variceal bleeding. The high risk factors related to early rebleeding were poor liver function and advanced hepatocellular carcinoma.

Análisis crítico de un artículo / Critical appraisal: Band ligation and propranolol are equally effective for primary prevention of variceal bleeding

In this randomized controlled multicenter trial, we compared endoscopic variceal banding ligation (VBL) with propranolol (PPL) for primary prophylaxis of variceal bleeding. One hundred fifty-two cirrhotic patients with 2 or more esophageal varices (diameter >5 mm) without prior bleeding were randomized to VBL (n=75) or PPL (n=77). The groups were well matched with respect to baseline characteristics (age 56±10 years, alcoholic etiology 51%, Child-Pugh score 7.2±1.8). The mean follow-up was 34±19 months. Data were analyzed on an intention-to-treat basis. Neither bleeding incidence nor mortality differed significantly between the 2 groups. Variceal bleeding occurred in 25% of the VBL group and in 29% of the PPL group. The actuarial risks of bleeding after 2 years were 20% (VBL) and 18% (PPL). Fatal bleeding was observed in 12% (VBL) and 10% (PPL). It was associated with the ligation procedure in 2 patients (2.6%). Overall mortality was 45% (VBL) and 43% (PPL) with the 2-year actuarial risks being 28% (VBL) and 22% (PPL). 25% of patients withdrew from PPL treatment, 16% due to side effects. In conclusion, VBL and PPL were similarly effective for primary prophylaxis of variceal bleeding. VBL should be offered to patients who are not candidates for long-term PPL treatment.

A Prospective Randomized Controlled Clinical Trial Comparing the Effects of Somatostatin and Vasopressin for Control of Acute Variceal Bleeding in the Patients with Liver Cirrhosis

BACKGROUND: Acute variceal bleeding is a serious complication of liver cirrhosis, which has an attendant mortality of approximately 60% over two years, and a variety of treatments, such as balloon tamponade, endoscopic varix ligation, sclerotherapy, histoacryl injection and vasoactive drugs, have been used. The aims of the present trial were to compare the effectiveness and complications of somatostatin and vasopressin in the treatment of acute variceal bleeding. METHODS: Forty-three cirrhotic patients, with endoscopically proven acute variceal bleeding, were included in this trial. Both drugs were given as continuous intravenous infusions for 48 hours. Twenty patients received the somatostatin (250 mcg per hr after a bolus of 50 mcg) and twenty-three the vasopressin (0.4 units per min). RESULTS: There were no significant differences between the two groups in relation to age, sex, etiology of cirrhosis, Child-Pugh classification, characteristics of bleeding episode, laboratory findings before randomization and units of transfused blood during therapy. Rebleeding, within 6 hours after beginning of therapy, was regarded as failure to control initial bleeding, and was observed in 3 (13.0%) of the patients who received vasopressin and in 1 (5.0%) treated with somatostatin (p> 0.05). Five patients in both the somatostatin (25.0%) and vasopressin (21.7%) groups rebled during the first 5 days following the initial therapy (p> 0.05). Meaningful complications related to the use of vasopressin were observed in 5 patients (chest pain or abdominal pain requiring nitroglycerin), but no complications were associated with the use of somatostatin (p< 0.05). The mortalities during hospitalization were similar in both the treatment groups. Two of the vasopressin and 1 of the somatostatin group died due to the uncontrolled rebleeding, and 1 of the vasopressin group died due to hepatic failure (2 weeks later after theropy). CONCLUSION: This study showed no differences in the effectiveness of somatostatin and vasopressin, but the somatostatin group had a lower risk of the complications.

Surgical hepatosplenic mansonic schistosomiasis in adolescents: repercussions of the post-treatment schistosomotic burden on the hepatic functional reserve

Schistosomiasis mansoni affects the hepatic functional reserve. Clinical treatment with oxamniquine is not 100 percent effective and there has been found strain of this parasite resistant to this drug. The aims of this investigation were: (1) to examine the presence of residual parasite burden after medical and surgical treatment on adolescents with surgical schistosomiasis mansoni and (2) to assess the effect on the hepatic functional reserve in patients with and without residual infection. Twenty nine children with hepatosplenic schistosomiasis mansoni and bleeding esophageal varices were treated with oxamniquine. They underwent splenectomy, ligature of the left gastric vein and autologous implantation of spleen tissue into the greater omentum. After a mean post-operative follow up of five years they underwent rectal biopsy for schistosomotic egg search. They were divided in patients with and without infection. In 20 patients the submucosal egg search was negative, however, in 9 it was positive. The hepatic functional reserve in the patients without infection was as follows: 17 were Child-Pugh A and 3 Child-Pugh B. In the patients who were still infected 6 were Child-Pugh A and 3 Child-Pugh B. The chi2 analysis of the hepatic functional reserve showed chi2 = 3.19 - p= 0.07. From the results the following conclusion can be drawn: residual infection or reinfection in the follow up period had not interfered with the distribution of the hepatic functional reserve of the patients in this series. However, there was a trend for a decrease of this parameter in patients with residual infection

Prospective randomized comparison of sodium tetradecyl sulphate & polidocanol for oesophageal variceal sclerotherapy.

BACKGROUND & OBJECTIVE: A number of sclerosing agents have been tried for sclerotherapy of oesophageal varices. However, none of them have emerged as an ideal agent. Hence, this study was designed to compare the efficacy and safety of sodium tetradecyl sulphate and polidocanol for sclerotherapy of oesophageal varices. METHODS: A total of 100 consecutive patients with bleeding oesophageal varices were included in the study. Patients with associated gastric varices and hypersplenism were excluded. Of the 100 patients, 50 received emergency sclerotherapy with either 3 per cent sodium tetradecyl sulphate or 3 per cent polidocanol, randomized using the sealed envelope technique. Following control of bleeding, these patients were included in the elective sclerotherapy schedule. The remaining 50 patients with past history of bleeding varices received elective sclerotherapy. Thus all 100 patients received elective sclerotherapy at 4 weekly intervals. RESULTS: There was no significant difference between the sodium tetradecyl sulphate and polidocanol groups with respect to the control of acute variceal bleeding (100% vs 96%), the mean number of injection sessions (4.5 +/- 0.3 vs 4.7 +/- 0.4) and the mean amount of scleroscent required (33.3 +/- 2.7 ml vs 37.0 +/- 3.3 ml) per patient for variceal eradication. The cost of polidocanol required for variceal obliteration was significantly higher than that of sodium tetradecyl sulphate (P < 0.001). The use of sodium tetradecyl sulphate in contrast to polidocanol was associated with a significantly higher incidence of variceal recurrence (11% vs 0%) and other complications such as oesophageal ulcer (14% vs 2%), retrosternal pain (22% vs 2%), fever (16% vs 4%), tachycardia (14% vs 2%) and dysphagia (20% vs 6%). Rebleeding rate and mortality rate were not significantly different between the two groups. INTERPRETATION & CONCLUSION: Polidocanol is superior to sodium tetradecyl sulphate as it has lower incidence of complications, even though the drugs are similar in efficacy in the control of bleeding and obliteration of varices in long-term.

Un análisis retrospectivo de cavernomatosis de la vena porta en Chile: II: hemorragia, tratamiento y pronóstico / A retrospective analysis of portal vein cavernomatosis in Chile: II: hemorrhage, treatment and prognosis

Objetivo: El tratamiento de la hipertensión portal de origen prehepático en niños es motivo de controversia. El objetivo de este estudio retrospectivo fue analizar la evolución, tratamiento y morbimortalidad de 34 niños con cabermomatosis de la vena porta. Pacientes y método: Se analizó la evolución antropométrica y hematológica, las características del sangramiento digestivo, el tratamiento médico, endoscópico y quirúrgico,y la morbimortalidad. Resultados: El 74 por ciento de los niños presentó uno o más episodios de sangramiento. El 56 por ciento de los niños recibió prepanolol como profilaxis y el 38 por ciento fue sometido a escleroterapia de várices esofágicas. Sólo seis niños requirieron de cirugia derivativa. La mortalidad fue el 5,6 por ciento y el seguimiento fue de 3,6 años por niño.Conclusión: Aun cuando la hemorragia digestiva alta por ruptura de las várices esofágicas fue la complicación más frecuente de la cavernomatosis de la porta en esta serie, el éxito del tratamiento médico y endoscópico en evitar un nuevo episodio de sangramiento sugieren que a futuro un número menor de pacientes requerirá de cirugía derivativa portosistémica

Sangramento por varizes esofágicas. O papel da farmacoterapia na profilaxia primária / Esophageal varices bleeding: prophilatic therapy to prevent initial haemorrhage

O sangramento decorrente da ruptura de varizes esofágicas está associado a uma alta taxa de mortalidade. Os mais confiáveis fatores preditivos de sangramento são: o gradiente de pressão venosa hepática, a presença de varizes de grande porte e de manchas avermelhadas sobre as mesmas. Este artigo de revisão mostra a inmportância da profilaxia primária, ressalta a eficácia dos beta-bloqueadores não seletivos e discute o papel dos nitratos

Octreotide: a clinical update

Somatostatin is found in the pancreas and gastrointestinal tract, including the visceral autonomic nervous system, the endocrine D cells and the gut lumen. Somatostatin peptides may act differently at different sites as hormones, as paracrine substances or neurotransmitters. So far not much is known on the physiological effects of somatostatin in the gastrointestinal tract. Somatostatin and octreotide, a synthetic analogue with a longer half-life and higher potency, inhibit the neuroendocrine and exocrine gastrointestinal secretion, intestinal glucose, fat and amino acid transport, intestinal propulsive and gallbladder motility, splanchnic blood flow in volunteers and hepatic venous pressure in cirrhotic patients. The inhibition occurs to various extents depending on the target organ. This review deals with the pharmacological effects of octreotide on different gastrointestinal functions and describes the therapeutic role in different gastrointestinal disorders

Vasoactive drugs in the management of acute Variceal bleeding

Several methods have been used to treat acute variceal hemorrhage. Sclerotherapy is the method of choice. The use of vasoactive drugs is popular despite unsatisfactory effect and systemic hemodynamic adverse effects. The recently introduced longacting somatostatin analogue, octreotide, is more effective and has no systemic adverse effects. it may be used while waiting for emergency sclerotherapy or in combination with sclerotherapy in patients with high risk of rebleeding