Other Treatments for Cirrhosis
are similar to varicose veins except that they occur in the lining of the walls of the lower esophagus (swallowing tube). They are a common complication of
. If the veins rupture, they can cause serious bleeding that often requires a blood transfusion.
Once bleeding is controlled, treatment focuses on preventing future bleeding episodes. Ruptured esophageal varices are responsible for a large proportion of the deaths associated with cirrhosis.
For Managing Cirrhosis
Endoscopy, which consists of a narrow tube mounted with a video camera being inserted into the throat, is used to identify the bleeding site. A rubber band is used to tie off the bleeding portion of the vein.
is again used to identify the bleeding site. It is only useful if the bleeding is in your esophagus. A drug, such as morrhuate sodium (Scleromate) is injected into the bleeding vein, causing it to constrict. This slows the bleeding and allows a clot to form, closing the ruptured vessel. It is necessary to repeat the procedure over 2-3 months to reduce the risk of bleeding again. There is recent evidence that combined endoscopic and drug treatment is more effective than either treatment alone in preventing variceal rebleeding.
Transjugular Intrahepatic Porto-Systemic Shunting (TIPS)
The TIPS procedure is the creation of an artificial connection directly between the portal veins and hepatic veins of your liver. The entire procedure is performed using needles, catheters, wires, and stents placed through a vein in your neck.
In this procedure, a catheter (tube) with a stent (a tube that shunts blood) attached to it is threaded through a vein in your neck into your liver. Using x-ray guidance, the stent is placed within your liver to allow blood to flow more easily through the portal vein. Once in place, the shunt allows blood to return directly to your heart without passing through the varices. TIPS is a good choice for bleeding that is not controlled by endoscopy.
American Liver Foundation
website. Available at:
http://www.liverfoundation.org. Accessed March 8, 2006.
Della Corte C, Alisi A, et al. Expert opinion on
current therapies for nonalcoholic fatty liver disease.
Expert Opin Pharmacother. 2011(12):1901-1911.
Gonzalex R. Meta-analysis: combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis.
Ann Intern Med. 2008;149:109-22.
National Institute of Diabetes and Digestive and Kidney Diseases
website. Available at:
http://www.niddk.nih.gov. Accessed March 7, 2006.
National Library of Medicine website. Available at:
http://www.nlm.nih.gov. Accessed March 8, 2006.