[Treatment of esophageal varices]

Patients with oesophageal varices without previous bleeding have a risk of 25-30% for the development of a bleeding episode within two years. It is important to identify patients with a high risk of bleeding due to the high mortality of 30-40% within six weeks after a bleeding episode. Treatment with a non-selective betablocker possibly combined with isosorbidnitrate should be initiated if an upper endoscopy shows the presence of medium- or large-sized oesophageal varices. Sclerotherapy or ligation initiated within a short time after start of an acute bleeding episode reduces mortality and risk of bleeding. Pharmacological treatment may have effect on the acute episode, and most data advocate for Terlipressin to be the first choice. If bleeding continues transjugular intrahepatic portosystemic shunt (TIPS) should be considered. Fifty to seventy percent of patients will experience a rebleeding episode if otherwise untreated. Endoscopic ligation should be preferred possibly in combination with a non-selective betablocker. If another bleed occurs the patient should be considered for TIPS or transplantation.