Portal hypertensive gastropathy medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Pharmacotherapies
Several treatment options have been developed for portal hypertensive gastropathy.
- Beta-blockers: The first is the use of beta-blockers, which reduce portal pressures. Non-selective beta blockers (such as propranolol and nadolol have been used to decrease the pressure of the portal vein in patients with esophageal varices, and have been shown to regress portal hypertensive gastropathy that has been worsened by medical treatment of varices.[1] Propranolol has also been evaluated in patients with chronic cirrhosis and portal hypertensive gastropathy [2]
- Anti fibrinolytics: Other medications that primarily treat bleeding, including anti-fibrinolytic medications such as tranexamic acid have also been used in case reports of patients with portal hypertensive gastropathy.[3] These medications work by stabilizing deposits of fibrin at sites that ordinarily would bleed.
- Octreotide: Finally, octreotide, an analogue of somatostatin that leads to vasoconstriction of the portal circulation, can be used for active bleeding due to portal hypertensive gastropathy.[4]
- Sucralfate: Sucralfate, a coating medication has also been used, but evidence is from animal models.[5]
Endoscopy
Portal hypertensive gastropathy can also be treated with endoscopic treatment delivered through a fibre-optic camera into the stomach. Argon plasma coagulation and electrocautery have both been used to stop bleeding from ectatic vessels, and to attempt to obliterate the vessels, but have limited utility if the disease is diffuse.[6][4]
References
- ↑ Lo GH, Lai KH, Cheng JS; et al. (2001). "The effects of endoscopic variceal ligation and propranolol on portal hypertensive gastropathy: a prospective, controlled trial". Gastrointest. Endosc. 53 (6): 579–84. PMID 11323582.
- ↑ Pérez-Ayuso RM, Piqué JM, Bosch J; et al. (1991). "Propranolol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis". Lancet. 337 (8755): 1431–4. PMID 1675316.
- ↑ McCormick PA, Ooi H, Crosbie O (1998). "Tranexamic acid for severe bleeding gastric antral vascular ectasia in cirrhosis". Gut. 42 (5): 750–2. PMID 9659175.
- ↑ 4.0 4.1 Garcia N, Sanyal AJ (2001). "Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia". 4 (2): 163–171. PMID 11469974.
- ↑ Geoffroy P, Duchateau A, Thiéfin G, Zeitoun P (1987). "Effects of propranolol and sucralfate on ethanol-induced gastric mucosal damage in chronic portal hypertensive rats". J. Hepatol. 5 (2): 162–6. PMID 3693860.
- ↑ Sato T, Yamazaki K, Toyota J; et al. (2005). "Efficacy of argon plasma coagulation for gastric antral vascular ectasia associated with chronic liver disease". Hepatol. Res. 32 (2): 121–6. doi:10.1016/j.hepres.2005.04.004. PMID 15967712.