Burroughs A K
Hepato-biliary and Liver Transplantation Unit, Royal Free Hospital, London.
Gut. 1994;35(3 Suppl):S23-7. doi: 10.1136/gut.35.3_suppl.s23.
Bleeding from oesophageal varices has a high death rate. Injection sclerotherapy is the most appropriate treatment but facilities for this are not always available. Balloon tamponade and vasoactive therapy may be used as stop gap measures. Somatostatin and octreotide are therapeutic candidates for the treatment of variceal bleeding and there are several trials that have compared somatostatin and octreotide with other treatments for this condition. The results of these trials are summarised and discussed. A meta analysis of the group of trials of placebo or H2 antagonists v somatostatin or octreotide showed a significant advantage of somatostatin or octreotide in terms of efficacy, but no difference in mortality. The trials discussed seem to show that somatostatin and octreotide are at least as effective as other treatments, with the benefit of fewer adverse effects, and thus represent the best vasoactive agents. Additionally, they may have a role as adjuvant treatment to emergency sclerotherapy for active bleeders and this must be further investigated.
食管静脉曲张出血死亡率很高。注射硬化疗法是最合适的治疗方法，但并非总能获得相关设备。气囊压迫和血管活性药物治疗可作为权宜措施。生长抑素和奥曲肽是治疗静脉曲张出血的候选药物，有多项试验比较了生长抑素和奥曲肽与其他治疗方法在这种情况下的疗效。现将这些试验结果进行总结和讨论。一项对安慰剂或H2拮抗剂与生长抑素或奥曲肽的试验组进行的荟萃分析显示，生长抑素或奥曲肽在疗效方面具有显著优势，但在死亡率方面无差异。所讨论的试验似乎表明，生长抑素和奥曲肽至少与其他治疗方法一样有效，且不良反应较少，因此是最佳的血管活性药物。此外，它们可能作为活动性出血患者紧急硬化疗法的辅助治疗，这一点必须进一步研究。
