PT  - JOURNAL ARTICLE
AU  - S W Hosking
AU  - W Doss
AU  - H el-Zeiny
AU  - P Robinson
AU  - M S Barsoum
AU  - A G Johnson
TI  - Pharmacological constriction of the lower oesophageal sphincter: a simple method of arresting variceal haemorrhage.
AID  - 10.1136/gut.29.8.1098
DP  - 1988 Aug 01
TA  - Gut
PG  - 1098--1102
VI  - 29
IP  - 8
4099  - http://gut.bmj.com/content/29/8/1098.short
4100  - http://gut.bmj.com/content/29/8/1098.full
SO  - Gut1988 Aug 01; 29
AB  - The effect of pharmacological constriction of the lower oesophageal sphincter (LOS) on oesophageal varices was investigated in an experimental study followed by a controlled clinical trial. In the experimental study intravariceal pressure was measured just above the LOS in 11 patients before and after constricting the LOS by intravenous pentagastrin. Intravariceal pressure fell from a mean of 23 (range 12-36) mmHg to 4 (range 0-7) mmHg (p less than 0.001). This marked pressure drop indicated the considerable compression of varices that occurred within the LOS. A prospective controlled clinical trial examined whether LOS constriction (effected by the longer acting metoclopramide) would compress varices sufficiently to arrest active variceal bleeding originating from the lowest 2 cm oesophagus--the area encircled by the LOS. Of 11 patients who received metoclopramide, 10 stopped bleeding compared with four of the 11 who received placebo (p less than 0.01). Pharmacological constriction of the LOS appears to offer a new and effective approach for arresting active bleeding from oesophageal varices.