Esophageal bleeding disorders.

PURPOSE OF REVIEW

Management of esophageal bleeding disorder remains a challenging problem. This review focuses on studies published in previous 12 months that provided further understanding on the appropriate treatment of various esophageal bleeding disorders. Other uncommon causes of esophageal bleeding will also be discussed in this review.

RECENT FINDINGS

With the advances in endoscopic and pharmacological treatments, mortality of variceal hemorrhage has been substantially reduced. Apart from its major role in initial treatment of variceal bleeding, mounting evidence shows that band ligation is a safe alternative to beta-blocker for primary prophylaxis and may even be used as an adjunct to the transjugular intrahepatic portosystemic stent shunt to obviate the need of long-term surveillance. While vasoactive agents remain the most important pharmacological treatment of esophageal variceal bleeding, antibiotic prophylaxis is also increasingly recognized to play a role in prevention of variceal rebleeding. The benefit of beta-blocker has now been extended to halt the progression of esophageal varices and combination of beta-blocker and band ligation remains the most cost-effective treatment strategy for secondary prophylaxis of variceal bleeding. Other new treatments such as endoloop and recombination factor VII have produced promising results. The clinical courses of variceal bleeding in patients with hepatocellular carcinoma and acute necrotizing esophagitis are now better defined.

SUMMARY

There are significant advances in the treatment of esophageal variceal bleeding and further understanding on the management and clinical courses of various esophageal bleeding disorders.