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Résultats des études contrôlées dans le traitement des hémorragies digestives liées à l’hypertension portale

Results from controlled studies on the treatment of digestive bleeding secondary to portal hypertension

  • Hypertension Portale Portal Hypertension
  • Published:
Acta Endoscopica

Conclusions

Le traitement des hémorragies actives repose sur les drogues vasoactives (somatostatine, octréotide, amines vasoactives associées le plus souvent à un traitement endoscopique en urgence différée. Les bétabloquants sont efficaces dans la prévention primaire et secondaire. En cas d’échec ou de mauvaise adhésion au traitement, les techniques endoscopiques sont efficaces, mais au prix de multiples séances et de contrôles réguliers. L’anastomose porto-cave et en particulier les PIPS sont efficaces, mais entrînent un assez grand nombre d’encéphalopathies porto-caves. La transplantation hépatique est le traitement idéal, puisqui’il traite à la fois l’hypertension portale et l’insuffisance hépato-cellulaire, mais il nepeut être réalisé que chez desmalades très sélectionnées.

Conclusion

The treatment of acute bleeding relies upon vasoactive drugs (somatostatin, octreotide, vasoactive amines), most of the time combined with an endoscopic treatment delayed after the emergency. Beta-adrenergic antagonists are efficient for primary and secondary prevention. In case of failure or poor compliance to the treatment, endoscopic techniques are efficient, but at the cost of multiple sessions and regular checkups. Porto-caval anastomoses, and in particular TIPS, are efficient but lead to a rather large number of hepatic encephalopathies. Liver transplanttaion is the ideal treatment, since it corrects at the same time portal hypertension and hepatocellular deficiency, but it can only be performed in highly selected patients.

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  1. Hôpital Saint-Antoine, Service de Gastro-Entérologie, 75571, Paris Cedex 12, France

    Ch. Florent & O. Ibn Salah

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Florent, C., Salah, O.I. Résultats des études contrôlées dans le traitement des hémorragies digestives liées à l’hypertension portale. Acta Endosc 30, 519–530 (2000). https://doi.org/10.1007/BF03026169

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