Combination of Endoscopic and Pharmacologic Treatment

A combination of continuous infusion of octreotide for 5 days along with either sclerotherapy or band ligation has been shown to be superior to either sclerotherapy or band ligation alone in reducing early rebleeding and mortality. The combination treatment appears to particularly benefit those patients with shock and ongoing bleeding. In addition, continuous infusion of octreotide also has been shown to be very effective in reducing bleeding from postsclerotherapy esophageal ulceration. other combination treatments, such as addition of isosorbide mononitrate to somatostatin, have not been shown to have any advantage over somatostatin alone. The current evidence favors the use of a combination of endoscopic treatment with either octreotide or somatostatin. These drugs should be started prior to endoscopy and continued for 5 to 7 days after the bleeding episode.

Until recently, it was generally accepted that immediate endoscopic treatment is the optimum treatment for active variceal bleeding, but is critically dependent upon available expertise to attain these high success rates and to minimize complications. The optimum timing of endoscopic treatment with respect to the bleeding episode remains unanswered. The options are immediate treatment with the associated technical difficulties, or delayed treatment after temporary hemostasis is achieved using vasoconstrictive drugs. Because the efficacy of somatostatin, octreotide or terlipressin is comparable to endoscopic treatment, it is reasonable to postpone endoscopy for treatment, as well as to confirm the diagnosis, until the patient is stabilized with pharmcologic intervention. Immediate endoscopic treatment could be reserved for nonresponders to pharmacologic intervention. To reduce early rebleeding, it is advisable to continue vasoconstrictors, such as somato-statin or octreotide (or terlipressin), for the first 5 to 7 days after the bleeding episode.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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