Author/Editor		Kovačič-Palli, Erika
Title		Preprečevanje ponovitev varikoznih krvavitev v prebavila
Translated title		Prevention of variceal rebleeding
Type		članek
Source		Gastroenterolog
Vol. and No.		Letnik 8, št. 1-2
Publication year		2004
Volume		str. 46-50
Language		slo
Abstract		Background. After an initial variceal hemorrhage, the maximal risk of recurent bleeding is in the first five days, then declines slowly over the first six weeks, and becomes virtually equal to that before the initial bleed after the sixth week. The risk of death is therefore increased as well. The currently available therapeutic options to prevent rebleeding include pharmacotherapy, endoscopic therapy, transjugular intrahepatic portosystemic shunt (TIPS), surgical shunt, and liver transplantation. Conclusaons. The first-line pharmacologic treatment for prevention of recurrent variceal hemorrhage is beta-blockade. Variceal band ligation should be used if there are contraindications or intolerance to beta-blockers. TIPS placement is appropriate for patients who rebleed and are refractory to endoscopic therapy, and, particulary, for those who are candidates for liver transplantation. Surgery is indicated in patients whose principal problem is portal hypertensive bleeding for recurrent TIPS stenosis and who have an adequate hepatic reserve. Liver transplantation is indicated primarily for patients with poor liver function concomitant with bleeding portal hypertension.
Summary		Izhodišča. Bolniki s portalno hipertenzijo, ki so že krvaveli iz požiralnikovih ali želodčnih varic, najpogosteje ponovno zakrvave v prvih petih dneh po hemostatskem posegu. Tveganje se manjša naslednjih šest tednov in se nato izenači s tistim pred prvo krvavitvijo. Zvečana je tudi smrtnost. Za preprečevanje ponovne krvavitve uporabljamo zdravila, ki znižajo portalni tlak, endoskopske posege, predvsem podvezovanje varic, uvajamo transjugularni intrahepatični portosistemski šant, izvajamo kirurške obvoze in izjemoma presadimo jetra. Zaključki. Zdravilo izbora za preprečevanje ponovitve varikozne krvavitve so neselektivni blokatorji adrenergičnih receptorjev beta. Kadar je zdravljenje z njimi neučinkovito ali če jih bolnik ne sme jemati, varice endoskopsko podvežemo. Če bolnik kljub temu ponovno zakrvavi, še posebno, če je pri njem predvidena presaditev jeter, se odločimo za vstavitev transjugularnega intrahepatičnega portosistemskega šanta (TIPS). Kirurško zdravljenje z obvozi je primerno le za bolnike z ohranjeno jetrno funkcijo, pri katerih se krvavitve ponavljajo zaradi stenoze TIPS-a. Presaditev jeter je indicirana ob slabi jetrni funkciji in krvavitvi zaradi portalne hipertenzije.
Descriptors		HYPERTENSION, PORTAL ESOPHAGEAL AND GASTRIC VARICES GASTROINTESTINAL HEMORRHAGE ADRENERGIC BETA-ANTAGONISTS SCLEROTHERAPY LIGATION PORTASYSTEMIC SHUNT, TRANSJUGULAR INTRAHEPATIC