MEDICAL VERSUS SURGICAL THERAPY IN THE PREVENTION OF RECURRENT BLEEDING OESOPHAGEAL VARICES

Abstract

Portal hypertension, is a complex syndrome which is accompanied by various abnormal circulatory dynamics. It can result from a single or multiple causative factors. The most common cause for portal hypertension in Egypt is schistosomiasis. Recently HCV related chronic liver disease proved to be an aggravating factor. Bleeding from esophageal varices is the most important complication of portal hypertention. It can be the presenting symptom of schistosoma! liver disease with high mortality rate.

About 33.3 - 80% of patients surviving the first episod of variceal hemorrhage will suffer from recurrence within one year period. Compared to the first attack, the mortality rate is higher in the recurrent episodes of bleeding.

Prophylaxis against recurrent bleeding from esophageal vances remains a major challenge. Multiple modalities of preventive therapy to guard agaist recurrent attacks of bleeding are currently in use. However no consensus about a single modality. Medical therapy in the form Beta blockers (especially propranolol), Isosorbide mononitrate and colchicine have long been tried . The outcome of their use in schistosoma!patients is not precisely evaluated.. Injection sclerotherapy and band ligation are also in use. They are effective to some extent in preventing secondary attacks of bleeding, but the survival rate has not been improved. Surgical therapy in the form of splenectomy and gastro-esophageal decongesion