Managment of acute esophageal variceal bleeding
DOI:
https://doi.org/10.12775/JEHS.2024.52.002Keywords
esophageal variceal hemorrhage, transjugular intrahepatic portosystemic shunt, balloon tamponade, self-expanding metallic stents, endoscopic variceal ligationAbstract
Krwawienie z żylaków przełyku jest poważnym powikłaniem nadciśnienia wrotnego spowodowanego marskością wątroby. Cele leczenia tej choroby obejmują kontrolę krwotoku, minimalizację ryzyka ponownego krwawienia, zapobieganie powikłaniom i zmniejszenie śmiertelności, co wymaga podejścia wielodyscyplinarnego. W ostrych epizodach interwencje obejmują leki wazoaktywne, antybiotyki i techniki endoskopowe. Klasyfikacja pacjentów przy użyciu gradientu ciśnienia żylnego wątroby (HVPG) i systemów punktacji pomaga w stratyfikacji ryzyka i szybkiej interwencji. Z farmakologicznego punktu widzenia leki wazoaktywne odgrywają kluczową rolę, a nowe strategie, takie jak transfuzja pod kontrolą TEG i wczesne TIPS, przyczyniają się do ewolucji standardów. Ogólnie rzecz biorąc, w ostatnich dziesięcioleciach nastąpił znaczny postęp w leczeniu krwawień z żylaków przełyku, poprawiający wyniki i udoskonalający podejścia terapeutyczne.
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