Pathophysiology and treatment of significant bleeding oesophageal varices

Acute oesophageal variceal haemorrhage is a major cause of death associated with cirrhotic liver disease. Whilst surgical procedures can decrease the risk of recurrent bleeds, pharmacological aids are often used to treat the cause of the varices: portal hypertension. Insertion of a Sengstaken Blakemore tube or Minnesota tube can temporarily halt the haemorrhage by exerting pressure on the varices. This pressure decreases the blood supply to the oesophagus, thereby decreasing the amount of blood lost through a ruptured vessel. The use of these tubes is based on individual hospital policy. Other techniques such as band ligation, are also being introduced for the management of oesophageal varices to decrease haemorrhaging. Once the bleeding has been controlled surgical procedures such as sclerotherapy can attempt to permanently stop the rupture. However, these procedures do not treat the cause of the varices. Adjunctive medications, transplants and shunts attempt to permanently decrease the portal hypertension in order to decrease the risk of recurrent haemorrhage.