Gastroösophageale Varizen – Prophylaxe und Therapie

Prognose. Zum Zeitpunkt der Erstdiagnose einer Le− berzirrhose liegen bereits bei ca. 50 % der Patienten Va− rizen vor [1]. Bei einem Drittel dieser Patienten kommt es im Verlauf zu einer Varizenblutung, einer Hauptur− sache von Morbidität und Mortalität bei Patienten mit Leberzirrhose. Aus diesem Grunde ist schon zum Zeit− punkt der Erstdiagnose einer Leberzirrhose als auch bei gastrointestinalem Blutverlust eine gründliche endo− skopische Diagnostik erforderlich. Jedes Ereignis einer ösophagogastralen Blutung ist mit einem Mortalitäts− risiko von 15±20 % assoziiert [2].

[1]  R. Groszmann,et al.  Portal hypertension and variceal bleeding—Unresolved issues. Summary of an American Association for the study of liver diseases and European Association for the study of the liver single‐topic conference , 2008, Hepatology.

[2]  A. Burroughs,et al.  A randomized study comparing ligation with propranolol for primary prophylaxis of variceal bleeding in candidates for liver transplantation , 2007, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[3]  F. Brunello,et al.  AT1 receptor antagonist Candesartan in selected cirrhotic patients: effect on portal pressure and liver fibrosis markers. , 2007, Journal of hepatology.

[4]  Angelo Luca,et al.  Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. , 2006, Gastroenterology.

[5]  V. Arroyo,et al.  Norfloxacin vs ceftriaxone in the prophylaxis of infections in patients with advanced cirrhosis and hemorrhage. , 2006, Gastroenterology.

[6]  J. Bosch,et al.  Pharmacological Reduction of Portal Pressure and Long-Term Risk of First Variceal Bleeding in Patients with Cirrhosis , 2006, The American Journal of Gastroenterology.

[7]  Ramon Planas,et al.  Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. , 2005, The New England journal of medicine.

[8]  T. Savides,et al.  Randomized study comparing banding and propranolol to prevent initial variceal hemorrhage in cirrhotics with high-risk esophageal varices. , 2005, Gastroenterology.

[9]  G. D’Amico,et al.  Upper digestive bleeding in cirrhosis. Post‐therapeutic outcome and prognostic indicators , 2003, Hepatology.

[10]  J. Bosch,et al.  Somatostatin and analogues in portal hypertension , 2002, Hepatology.

[11]  J. García‐Pagán,et al.  TIPS versus drug therapy in preventing variceal rebleeding in advanced cirrhosis: A randomized controlled trial , 2002, Hepatology.

[12]  J. Boadas,et al.  Somatostatin treatment and risk stratification by continuous portal pressure monitoring during acute variceal bleeding. , 2001, Gastroenterology.

[13]  T. Poynard,et al.  Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: A meta‐analysis , 1999, Hepatology.

[14]  J. Rodés,et al.  Propranolol compared with propranolol plus isosorbide-5-mononitrate for portal hypertension in cirrhosis. A randomized controlled study. , 1991, Annals of internal medicine.

[15]  R. Groszmann,et al.  Portal pressure, presence of gastroesophageal varices and variceal bleeding , 1985, Hepatology.

[16]  D. Graham,et al.  The course of patients after variceal hemorrhage. , 1981, Gastroenterology.

[17]  J. Bosch,et al.  The management of portal hypertension: rational basis, available treatments and future options. , 2008, Journal of hepatology.

[18]  K. Yokote.  [Pharmacological treatment]. , 2007, Nihon rinsho. Japanese journal of clinical medicine.

[19]  R. de Franchis.  Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. , 2005, Journal of hepatology.

[20]  G. D’Amico,et al.  Pharmacological Treatment of Portal Hypertension: An Evidence-Based Approach , 1999, Seminars in liver disease.