Reduction of portal pressure via reduction of portal-venous inflow → improved prognosis: fewer complications of portal hypertension and consequently reduced mortality (morbidity). Suitable for long-term therapy – also in terms of primary and secondary prophylaxis of variceal bleeding:
Propranolol (nonselective beta-blocker) – first-line agent; reduction of heart rate and cardiac output (HRV) and reduction of splanchnic blood flow (visceral blood flow).
Long-term therapy with non-selective beta-blockers (NSBBs) can reduce portal pressure by ≥ 20% of the original value or to ≤ 12 mmHg in 30-40% of affected individuals.
Primary prophylaxis of variceal bleeding:
Goal: avoid first esophageal variceal or fundal variceal bleeding.
The risk of first variceal bleeding is approximately 30%.
Indications for primary prophylaxis: increased risk of bleeding = large varices, (“red color signs” or stage III).
Permanent use of non-selective beta-blockers, e.g. propranolol; bleeding risk can thus be reduced by about 50%.
In acute esophageal variceal or fundus variceal bleeding:
Vasoactive substances such as terlipressin, somatostatin(-derivatives) – vasopressin is used less and less because of significant side effects!
Bleeding can often be stopped at least in the short term by medication.
In the therapy of acute esophageal variceal bleeding should always also antibiosis / antibiotic therapy (eg, with ciprofloxacin) to prevent sepsis (blood poisoning); therapy duration 5-7 days; in addition, the risk of early bleeding recurrence (recurrence of bleeding) is reduced
Secondary prophylaxis, as recurrent bleeding is common!
In early bleeding recurrences: renewed administration of vasoactive substances as well as antibiotic infection prophylaxis for esophageal variceal bleeding.
The risk of subsequent recurrent hemorrhage can be minimized by, among other things, permanent use of nonselective beta-blockers.
After variceal hemorrhage: prophylaxis of coma hepaticum (hepatic coma)!
Suction of the bloody stomach contents to reduce the protein load on the liver.
