A contemporary approach to the treatment from esophageal and gastric varices

Varikoziteti jednjaka i želuca uzrokuju krvarenje iz gornjeg gastrointestinalnog sustava u 13 – 25% slučajeva. Varikoziteti jednjaka i želuca posljedica su portalne hipertenzije, čiji je najčešći uzrok ciroza jetre. Na varikozitete jednjaka treba sumnjati kod pacijenata s krvarenjem iz gornjeg probavnog trakta koji uz to imaju cirozu jetre ili bilo kakvu drugu bolest koja može uzrokovati portalnu hipertenziju. Znakovi i simptomi krvarenja gornjeg probavnog sustava su hematemeza, melena, abdominalna bol, vrtoglavica i sinkopa. Zlatni standard pri postavljanju dijagnoze varikoziteta jednjaka i želuca je endoskopija gornjeg probavnog sustava – ezofagogastroduodenoskopija. Čimbenici koji mogu pomoći u procjeni rizika krvarenja iz varikoziteta su: lokalizacija variksa, veličina variksa, izgled variksa, kliničke značajke pacijenta i intravaricealni tlak. Profilaksa je izrazito važna kako bi se smanjila ukupna smrtnost kod pacijenata s cirozom jetre. Razlikujemo primarnu i sekundarnu profilaksu. Primarnom preveniramo inicijalno krvarenje iz varikoziteta, dok sekundarnom preveniramo ponovne epizode krvarenja u pacijenata koji su već doživjeli hemoragiju. Neselektivni beta blokatori i endoskopska ligacija varikoziteta metode su izbora u primarnoj i sekundarnoj profilaksi krvarenja srednjih i velikih varikoziteta jednjaka. Pacijentima koji akutno krvare iz varikoziteta jednjaka i želuca potrebno je osigurati hemodinamsku stabilnost nadoknadom tekućine, ordinirati antibiotsku profilaksu i primjenom vazoaktivnih lijekova smanjiti portalni tlak. Varicealno krvarenje zbrinjava se endoskopski. Endoskopska ligacija varikoziteta smatra se prvom linijom liječenja krvarenja varikoziteta jednjaka i gastroezofagealnih varikoziteta tip 1, dok je endoskopska terapija tkivnim ljepilima, primarno cijanoakrilatom, prva linija terapije za zbrinjavanje gastroezofagealnih varikoziteta tip 2, izoliranih varikoziteta želuca tip 1 i izoliranih varikoziteta želuca tip 2.Gastrointestinal bleeding is divided into bleeding from the upper gastrointestinal system and bleeding from the lower gastrointestinal system, depending on whether the bleeding is proximal or distal to the duodenojejunal junction (Treitz ligament). Approximately 80% of gastrointestinal bleeding originates from the upper gastrointestinal tract. Esophageal and gastric varices cause upper gastrointestinal bleeding in 13 - 25% of cases. Esophageal and gastric varices develop as a consequence of portal hypertension, the most common cause of which is cirrhosis of the liver. Esophageal varices should be suspected in patients with upper gastrointestinal bleeding who have cirrhosis of the liver or any other disease that may cause portal hypertension. Signs and symptoms of upper gastrointestinal bleeding include haematemesis, melena, abdominal pain, dizziness, and syncope. The initial evaluation of a patient with a suspected clinically significant acute upper GI bleed includes a history, physical examination, and laboratory tests. The gold standard in diagnosis of esophageal and gastric varices is endoscopy of the upper gastrointestinal system - esophagogastroduodenoscopy. Factors that may help assess the risk of variceal bleeding include: localization of the varices, size of the varices, appearance of the varices, clinical features of the patient, and intravariceal pressure. Prophylaxis is extremely important to reduce overall mortality in patients with cirrhosis of the liver. We distinguish between primary and secondary prophylaxis. The primary prevents initial bleeding from varices, while the secondary prevents recurrent bleeding episodes in patients who have already experienced hemorrhage. Nonselective beta blockers and endoscopic variceal ligation are the methods of choice in primary and secondary prophylaxis of bleeding of medium and large esophageal varices. Patients who bleed from esophageal and gastric varices should be provided with hemodynamic stability by fluid replacement, antibiotic prophylaxis should be administered, and vasoactive drugs should be used to reduce portal pressure. Varicose bleeding is managed endoscopically. Endoscopic variceal ligation is considered the first line of treatment for bleeding esophageal varices and gastroesophageal varices type 1, while endoscopic tissue adhesive therapy, primarily cyanoacrylate, is the first line therapy for gastroesophageal varices type 2, isolated gastric varices type 1 and isolated gastric varices type 2