Emergency treatment of BOV
Bleeding should always be treated as an emergency and it is vital that blood pressure in the portal vein is reduced as quickly as possible to reduce the bleeding and minimise the risk of liver and kidney failure.  The faster the treatment is started, the greater its chance of success.  

Several drugs have been tried in the treatment of bleeding varices. Vasoactive drugs, such as Ferring’s GLYPRESSIN (terlipressin), decrease the blood pressure in the portal vein. It is consequently for many physicians a treatment of choice for this life-threatening condition. 

GLYPRESSIN works by causing a vasoconstriction, or narrowing, of the blood vessels within the body’s internal organs.  This reduces the amount of blood reaching the portal vein relieving the pressure on the bleeding varices. 

Medical support of BOV
A variety of supportive methods are also used, including transfusions of whole blood and plasma proteins (albumin) to replace lost fluid, maintaining blood volume and pressure to ensure that the kidneys and liver carry on working.

It is sometimes necessary to use additional techniques to help control serious bleeding.  One technique, which is rarely used today, involves the insertion of a “balloon” device into the stomach and oesophagus via a tube and commonly a Sengstaken-Blakemore tube), which when inflated, applies pressure to the bleeding varices reducing the blood loss.
 
Occasionally, a surgical procedure called TIPS (transjugular intrahepatic portal-systemic stent shunt) is required. This is a minimally invasive technique that involves the insertion of a metal tube known as a stent into the liver, bypassing some of the blood flow from the liver to another venous system (the cava system).

This procedure relieves excess blood pressure in the liver and restores blood flow.  This is analogous to the technique used in the narrowed arteries of the heart affected by coronary heart disease.

TIPS is effective in relieving the excess blood pressure in the portal vein but it takes many hours to perform and carries its own risk of complications.  In extreme cases of liver cirrhosis, liver transplantation may be the only effective treatment.

Prevention of oesophageal bleeding
For those with varices at risk of bleeding, regular drug treatment can sometimes reduce the risk and the severity should it occur.  Preventative treatment usually consists of taking regular beta-blocker medication that helps to reduce the increased pressure in the portal vein and thus the pressure in the varices.