Medicines to Treat Esophageal Varices

Definition

The term "esophageal varices" refers to a pathology characterized by an "abnormal dilation of the veins located in the lower part of the esophagus, a typical condition of patients with severe liver disease. When ruptured, esophageal varices can create life-threatening bleeding and hemorrhage.

Causes

Esophageal varices are a common consequence of portal hypertension, which in turn is secondary to liver cirrhosis and alcoholic hepatitis. Other causes associated with the formation of esophageal varices include: parasitic infestations (eg schistosomiasis), liver scar lesions and thrombosis responsible for obstruction of the portal vein.

Symptoms

In addition to the difficulty in swallowing, esophageal varices do not begin with any particular symptoms, with the exception of the bloody ones; in the latter case, the haemorrhage can cause hematemesis (the patient vomits blood), tarry and black stools and, in severe cases, shock. Clearly, when esophageal varices result from liver disease (cirrhosis), the patient will also complain of all the symptoms of the underlying pathology.

Information on Esophageal Varices - Esophageal Varicose Treatment Drugs is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Esophageal Varices - Medicines for the Treatment of Esophageal Varices.

Medicines

Bleeding esophageal varices require immediate medical attention: it is estimated, in fact, that one in every 5 patients affected by bleeding episodes cannot overcome the disease. There are drugs and medical procedures that can stop the bleeding caused by esophageal varices: we are talking about very important treatments not only for the cure of the problem but also for the prevention of complications.
The choice of drugs and medical procedures clearly depends on the severity of the esophageal varices and the risk of bleeding: these aspects are evaluated thanks to a diagnostic test called esophagus-gastro-duodenoscopy.
In some cases, the patient is subjected to alternative treatments, useful for avoiding any exogenous bleeding:

1. ligation of esophageal varices
2. sclerotherapy (injection of a vasoconstrictor drug into the bleeding vein, useful for promoting clot formation in the varicose veins)

In some patients, the bleeding caused by the rupture of the esophageal varices is such as to require a blood transfusion; in extreme cases, especially for esophageal varices related to severe cirrhosis, it is necessary to act by reducing the pressure inside the veins; this is possible by creating an artificial venous bridge that diverts blood from the portal vein to the vena cava or renal vein (a decompression of the portal vein is achieved)

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The following are the classes of drugs most used in the therapy against esophageal varices, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:

Non-selective beta blockers: they constitute the first line therapy in the prevention of bleeding from esophageal varices. These drugs exert their therapeutic activity by reducing both cardiac output and portal pressure, creating splanchnic vasoconstriction.

• Propanolol (eg Inderal) widely used in therapy for the treatment of hypertension, angina pectoris and thyrotoxicosis, propanolol is also used as a drug of first choice to prevent bleeding of esophageal varices.
• Nadolol (eg Corgard): particularly effective in preventing bleeding relapses. The dosage, which must always be precisely established by the doctor on the basis of the severity of the condition, must be such as to reduce the heart rate by 25% (not less than 55 pul / min). Indicatively, the drug should be taken once a day at the initial dosage of 20 mg. The dose can be increased, always under medical observation, up to a maximum of 240 mg.

Nitrates: their therapeutic use for the treatment of esophageal varices is indicated above all in the prevention of bleeding relapses, especially when used in combination with beta-blocking drugs.

• Isosorbide 5 mononitrate (eg Duronitrin, Monoket, Monocinque Retard, Isosorbide MYL): The drug is used in therapy for the reduction of portal pressure. The dosage should be carefully established by the doctor.

Hormones (vasopressin analogues): these are drugs used both in the prevention and in the treatment of bleeding esophageal varices: vasopressin and its analogues are able to exert a reduction in the blood flow entering the portal vein, consequently the portal pressure decreases and the variceal bleeding is denied.

• Terlipressin (eg. Glipressin): the drug is available in the form of powder or solvent for intravenous injectable solutions (1 mg of active ingredient). Administration of this drug for the treatment of esophageal varices must be carried out in a hospital setting by an expert in the field.

Sclerosing agents:

• Ethanolamine oleate (eg. Ethamolin): start treatment with a dose of active variable between 1.5 and 5 ml for varices, to be administered intravenously (do not exceed 20 ml per treatment session for esophageal varices).