What drug and endoscopic treatments are used for acute variceal bleeding, and why are antibiotics given?

Vasoactive drugs reduce portal pressure: terlipressin (a vasopressin/V1 agonist causing splanchnic vasoconstriction) or octreotide (a somatostatin analogue). Urgent endoscopy achieves haemostasis by variceal band ligation (or sclerotherapy). Prophylactic antibiotics reduce infection, rebleeding, and mortality.

Clinical relevance. Combining vasoactive drugs, endoscopic banding, and antibiotics controls variceal bleeding and improves survival.

More Detail

Drug and endoscopic treatment of variceal bleeding

Pharmacological portal-pressure reduction, endoscopic haemostasis, and antibiotic prophylaxis together control bleeding and improve survival.

Vasoactive drugs (reduce portal pressure)

• Terlipressin: a vasopressin (V1-receptor) agonist that constricts the splanchnic arteries and reduces portal blood flow.
• Octreotide: a somatostatin analogue that lowers portal pressure (inhibits glucagon and acts on vascular smooth muscle).

Endoscopic haemostasis

• Variceal band ligation is the preferred method; sclerotherapy is an alternative.
• For gastric varices, tissue glue may be used.

Antibiotics

• Prophylactic antibiotics (e.g. a cephalosporin) are given to all cirrhotic patients with GI bleeding - they significantly reduce bacterial infections, rebleeding, mortality, and hospital stay.

Rescue measures

• Balloon tamponade (Sengstaken-Blakemore tube) to buy time if bleeding is uncontrolled; TIPS (transjugular intrahepatic portosystemic shunt) for refractory bleeding.