Successful treatment of repeated hematemesis secondary to postsclerotherapy esophageal ulcer in a cirrhotic patient: A case report

Drug Discov Ther. 2018;12(5):309-314. doi: 10.5582/ddt.2018.01056.

Abstract

Esophageal variceal bleeding is a common lethal complication of cirrhosis. Endoscopic injection sclerotherapy (EIS) is one of the major endoscopic approaches for treating esophageal variceal bleeding. However, complications may occur after EIS, which mainly include retrosternal discomfort/pain, dysphagia, re-bleeding, esophageal ulcer, esophageal strictures, and esophageal perforation, etc. In this article, we reported a 36-year-old male who developed esophageal ulcer related bleeding after EIS. Currently, there is no consensus on the treatment strategy for esophageal ulcer-related bleeding after EIS. In the present case, the following treatment strategy may be effective for ulcer related bleeding. The first step is to inhibit gastric acid secretion and reduce portal pressure by intravenous infusion of esomeprazole and somatostatin, respectively. The second is local hemostasis by oral norepinephrine and lyophilizing thrombin powder. The third is to protect digestive tract mucosa by oral Kangfuxin Ye and aluminum phosphate.

Keywords: Esophageal varices; endoscopic band ligation; endoscopic injection sclerotherapy; esophageal ulcer; portal hypertension.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aluminum Compounds / administration & dosage
  • Aluminum Compounds / therapeutic use
  • Esomeprazole / administration & dosage
  • Esomeprazole / therapeutic use
  • Esophageal and Gastric Varices / therapy*
  • Hematemesis / drug therapy*
  • Hematemesis / etiology
  • Humans
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / drug therapy
  • Male
  • Materia Medica / administration & dosage
  • Materia Medica / therapeutic use
  • Norepinephrine / administration & dosage
  • Norepinephrine / therapeutic use
  • Phosphates / administration & dosage
  • Phosphates / therapeutic use
  • Sclerotherapy / adverse effects*
  • Somatostatin / administration & dosage
  • Somatostatin / therapeutic use
  • Thrombin / administration & dosage
  • Thrombin / therapeutic use
  • Treatment Outcome
  • Ulcer / complications
  • Ulcer / drug therapy
  • Ulcer / etiology*

Substances

  • Aluminum Compounds
  • Materia Medica
  • Phosphates
  • kangfuxin
  • Somatostatin
  • Thrombin
  • aluminum phosphate
  • Esomeprazole
  • Norepinephrine