The evolution of available pharmacological treatments for variceal bleeding secondary to portal hypertension: A scope review

Abstract

Variceal bleeding is one of the main complications of portal hypertension and it presents with 30 to 50% mortality in hospitalized patients. During the period between 1990 to 2017, more than 1.32 million deaths in the world were related to cirrhosis what makes necessary to map available treatments to variceal bleeding secondary to portal hypertension and to analyze the results of the described treatments. The method selected to this study is a scoping review based on the methodology proposed by the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist (PRISMA-SCr) guidelines. The guiding question was defined as: "What treatments are available for variceal bleeding secondary to portal hypertension?". Based on these, 2870 articles were identified in the databases, 2446 were screened and 562 were selected for analysis by title and abstract. The texts analyzed in full totaled 110, of which 36 articles published between 2001 and 2020 were selected, with quantitative approaches, case reviews, literature reviews, meta-analyses, and guidelines. It is concluded that beta-blockers are the drugs of choice for primary prophylaxis of variceal bleeding. As for secondary prophylaxis, there is an association of these with nitrates and endoscopic ligation. With regard to acute bleeding, the use of vasoactive drugs is chosen, especially terlipressin. Finally, it is important to emphasize that there is a shortage of clinical studies and a need for investment in new therapies.