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首页> 外文期刊>Current opinion in gastroenterology >Esophageal bleeding disorders.
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Esophageal bleeding disorders.

机译：食道出血性疾病。

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PURPOSE OF REVIEW: Esophageal varices and Mallory Weiss syndrome are the two major esophageal bleeding disorders. Although there have been major breakthroughs in the treatment of peptic ulcer bleeding, the management of esophageal bleeding disorders remains a challenging problem. This review focuses on studies published in the previous 12 months that provide further understanding of the appropriate treatment of various esophageal bleeding disorders. Other uncommon causes of esophageal bleeding are also discussed. RECENT FINDINGS: With the advances in endoscopic and pharmacologic treatments, mortality resulting from variceal hemorrhage has been substantially reduced. Band ligation is the first-line endoscopic treatment of esophageal variceal hemorrhage. Vasoactive agents such as somatostatin analog and terlipressin are both safe and effective pharmacologic treatments of esophageal variceal hemorrhage. Use of a nonselective beta-blocker is still the most widely accepted treatment for both primary and secondary prophylaxis. However, the effectiveness of beta-blockers is limited by intolerance and nonresponders in a significant proportion of patients. Thus, endoscopic band ligation is used increasingly as an alternative strategy for primary prophylaxis. A transjugular intrahepatic portosystemic shunt should be reserved as rescue therapy for failure of medical and endoscopic treatments. In recent years, noninvasive surrogate markers have been reported to identify high-risk patients with large esophageal varices. Platelet count, spleen diameter, and their ratio are accurate predictors of esophageal varices in patients with cirrhosis. The endosonographic measurement of the cross-sectional surface area predicts the risk of variceal hemorrhage. For Mallory Weiss syndrome, endoscopic clipping is an emerging treatment modality, especially for deep laceration with risk of perforation. SUMMARY: A combination of various clinical, laboratory, and endosonographic parameters accurately predicts the risk of variceal hemorrhage. A streamlined screening strategy allows more cost-effective use of endoscopy and prompt prophylactic treatment for high-risk esophageal varices.
机译：审查目的：食管静脉曲张和马洛韦斯综合征是两种主要的食道出血性疾病。尽管在消化性溃疡出血的治疗方面取得了重大突破，但是食管出血性疾病的管理仍然是一个具有挑战性的问题。这篇综述的重点是在过去12个月中发表的研究，这些研究对各种食道出血性疾病的适当治疗提供了进一步的了解。还讨论了食管出血的其他罕见原因。最新发现：随着内窥镜和药物治疗的进步，静脉曲张破裂出血的死亡率已大大降低。束带结扎是食管静脉曲张破裂出血的一线内镜治疗。血管生长抑制素类似物和特利加压素等血管活性剂是食管静脉曲张破裂出血的安全有效药物治疗。对于一级预防和二级预防，非选择性β受体阻滞剂的使用仍然是最广泛接受的治疗方法。但是，在相当大比例的患者中，β受体阻滞剂的有效性受到不耐受和无反应者的限制。因此，内镜带结扎术越来越多地用作一级预防的替代策略。对于医学和内镜治疗失败的患者，应保留经颈静脉肝内门体分流术作为抢救疗法。近年来，已经报道了使用非侵入性替代标志物来鉴定具有较大食管静脉曲张的高危患者。血小板计数，脾脏直径及其比例是肝硬化患者食管静脉曲张的准确预测指标。横截面的超声检查可以预测静脉曲张破裂出血的风险。对于Mallory Weiss综合征，内窥镜钳夹是一种新兴的治疗方式，尤其是对于具有穿孔风险的深裂伤。摘要：各种临床，实验室和超声检查参数的组合可以准确预测静脉曲张破裂出血的风险。简化的筛查策略可提高内镜检查的成本效益，并能对高风险的食管静脉曲张及时进行预防性治疗。

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