How do you treat esophageal varices?

Answer 1

By a procedure called "banding". It involves an endoscopy, during which a medical "band" (which is a bit like an elastic band used in stationary etc...) is placed over the varices which appear most at risk of bleeding. This band constricts the blood flow, resulting in the bulging part of the vein having to heal over and fall off (and is then digested harmlessly). In most procedures, normally 2-5 bands will be placed; the higher the number, the slightly more uncomfortable for the patient it is afterwards (indigestion-like pain, which typically will only occur after eating during the first two days after the procedure).

In a way, the technique used is very similar to the vetinary method used in docking the tails of young lambs - where an elastic band is placed around their tails to restrict the bloodflow.

Banding is a prophelatcic procedure; it helps to prevent bleeding from the varices, but doesn't really do anything to prevent new varices from forming. This is why most people requiring banding will have it done periodically, at around 3 month intervals.

Indigestion remedies such as sucralfate, zantac, omeprazole etc... are also typically used in the treatment of esophageal varices - they don't do much to prevent bleeding, however they do reduce the amount of discomfort caused by the varices.

Answer 2

vasopressin and somatostatin are administered to actively bleeding patients on admission, while propranolol, nadolol or subcutaneous octreotide are used to prevent subsequent bleeding