ALCOHOL AND ESOPHAGEAL-VARICES

Citation
R. Sutton et R. Shields, ALCOHOL AND ESOPHAGEAL-VARICES, Alcohol and alcoholism, 30(5), 1995, pp. 581-589
Citations number
59
Language
INGLESE
art.tipo
Review
Categorie Soggetti
Substance Abuse
Journal title
ISSN journal
0735-0414
Volume
30
Issue
5
Year of publication
1995
Pages
581 - 589
Database
ISI
SICI code
0735-0414(1995)30:5<581:AAE>2.0.ZU;2-U
Abstract
Oesophageal varices are abnormally dilated veins that develop beneath the mucosa of the lower oesophagus and upper stomach and cause profoun d gastrointestinal haemorrhage associated with a high mortality. Varic es develop in the presence of portal hypertension, which, in Europe an d the USA, is most commonly due to alcoholic cirrhosis of the liver. A lcoholic cirrhosis develops in 10-20% of chronic ethanol abusers as a result of prolonged hepatocyte damage, leading to centrilobular inflam mation and fibrosis. The net effect on the portal venous system is an elevation of resistance, and/or increase of inflow, producing portal h ypertension, and the development of collateral channels in the: form o f varices. Such parenchymal liver disease also causes ascites, clottin g deficiencies, secondary malnutrition and hepatic encephalopathy, all of which contribute to the high mortality associated with variceal ha emorrhage. Variceal bleeding is more likely to occur when the varices are large, long and numerous, with surface red markings, and may be pr ecipitated by respiratory tract infection, nonsteroidal anti-inflammat ory drugs, alcohol, or may occur spontaneously. Once identified by end oscopy, the aims of management are to control the haemorrhage, to prev ent recurrent haemorrhage, and to treat the underlying cause of portal hypertension. Attention to nutrition and long-term rehabilitation are particularly important in those alcoholic cirrhotic patients who surv ive.