Worldwide practices for pharmacologic therapy in esophageal variceal hemorrhage

Pharmacologic therapy (PT) for patients with esophageal variceal hemorrhage (EVH) may improve outcomes. The aim of this article is to assess the current and potential future use of PT in cirrhotic patients with EVH.

We validated a 13-question survey about PT and physician preferences for specific therapies in cirrhotics with EVH; 2349 randomly selected Gastroenterology and Hepatology physicians worldwide were surveyed. The survey addressed institutional location, octreotide or terlipressin use and preference, PT prior to endoscopy, and future plans for terlipressin use, if not already instituted.

Of those surveyed, 337 (14%) email addresses were nonfunctioning. Of the remaining 2012 surveyed, 371 (18%) responses were collected. Nearly two-thirds of physicians preferred to use PT prior to endoscopic intervention (p < 0.001). Nearly 70% of respondents only had octreotide available, while 6% had only terlipressin. Of the 24% having both octreotide and terlipressin available, 55% preferred terlipressin compared to 38% who preferred octreotide (p < 0.001). Of those physicians currently not using terlipressin because of its unavailability, 93% would be willing to use it if it were readily available.

Of physicians with both terlipressin and octreotide available for treatment of EVH in cirrhotics, most prefer terlipressin, even if currently unavailable.