Boregowda Umesha, Umapathy Chandraprakash, Halim Nasir, Desai Madhav, Nanjappa Arpitha, Arekapudi Subramanyeswara, Theethira Thimmaiah, Wong Helen, Roytman Marina, Saligram Shreyas
Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, CA 93721, United States.
Department of Gastroenterology and Hepatology, Kansas University Medical Center, Kansas City, KS 66160, United States.
World J Gastrointest Pharmacol Ther. 2019 Jan 21;10(1):1-21. doi: 10.4292/wjgpt.v10.i1.1.
Cirrhosis of liver is a major problem in the western world. Portal hypertension is a complication of cirrhosis and can lead to a myriad of pathology of which include the development of porto-systemic collaterals. Gastrointestinal varices are dilated submucosal veins, which often develop at sites near the formation of gastroesophageal collateral circulation. The incidence of varices is on the rise due to alcohol and obesity. The most significant complication of portal hypertension is life-threatening bleeding from gastrointestinal varices, which is associated with substantial morbidity and mortality. In addition, this can cause a significant burden on the health care facility. Gastrointestinal varices can happen in esophagus, stomach or ectopic varices. There has been considerable progress made in the understanding of the natural history, pathophysiology and etiology of portal hypertension. Despite the development of endoscopic and medical treatments, early mortality due to variceal bleeding remains high due to significant illness of the patient. Recurrent variceal bleed is common and in some cases, there is refractory variceal bleed. This article aims to provide a comprehensive review of the management of gastrointestinal varices with an emphasis on endoscopic interventions, strategies to handle refractory variceal bleed and newer endoscopic treatment modalities. Early treatment and improved endoscopic techniques can help in improving morbidity and mortality.
肝硬化在西方世界是一个主要问题。门静脉高压是肝硬化的一种并发症，可导致多种病理状况，其中包括门体侧支循环的形成。胃肠道静脉曲张是扩张的黏膜下静脉，通常发生在胃食管侧支循环形成部位附近。由于酒精和肥胖，静脉曲张的发病率正在上升。门静脉高压最严重的并发症是胃肠道静脉曲张导致的危及生命的出血，这与相当高的发病率和死亡率相关。此外，这会给医疗机构带来巨大负担。胃肠道静脉曲张可发生在食管、胃或异位静脉曲张。在门静脉高压的自然史、病理生理学和病因学的理解方面已经取得了相当大的进展。尽管有内镜和药物治疗的发展，但由于患者病情严重，静脉曲张出血导致的早期死亡率仍然很高。复发性静脉曲张出血很常见，在某些情况下，存在难治性静脉曲张出血。本文旨在全面综述胃肠道静脉曲张的管理，重点是内镜干预、处理难治性静脉曲张出血的策略和更新的内镜治疗方式。早期治疗和改进的内镜技术有助于降低发病率和死亡率。
