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The Management of Bleeding Esophageal Varices

Joseph F. Dasta, MSc
JAMA. 1987;257(1):29-30. doi:10.1001/jama.1987.03390010033020.
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To the Editor.—  The article by Cello et al1 provides an excellent update on the drug and nondrug management of patients with hemorrhaging esophageal varices. In discussing vasopressin therapy, the authors mention that nitroglycerin can ameliorate some of the side effects of vasopressin; however, controlled trials evaluating the efficacy of combination therapy have not been published. Because nitroglycerin may cause an additional decrease in portal pressure, two recently published studies were conducted to evaluate the beneficial effect of nitroglycerin in the setting of acute variceal hemorrhage.Gimson et al2 randomized 57 patients with acute variceal bleeding into groups, one receiving vasopressin alone (0.4 U/min) and one receiving vasopressin at the same dosage plus intravenous nitroglycerin (40 μg/min titrated to blood pressure, with a maximal dose of 400 μg/min). At the end of 12 hours, cessation of bleeding was statistically more frequent in patients receiving combination therapy than those


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