A discussion of how terlipressin limits mortality in cases of bleeding oesophageal varices.

Bleeding oesophageal varices (BOV) are a potentially life-threatening complication of portal hypertension. While endoscopic sclerotherapy and banding ligation are often employed in an attempt to arrest bleeding, the use of vasoactive pharmacological agents to control haemorrhage has a number of advantages. While many of the available vasoactive agents control acute bleeding and may exert a beneficial influence over hepatic haemodynamics, terlipressin (triglycyl lysine-vasopressin) is the only agent that has been shown actually to decrease mortality in cases of BOV. It is hypothesized that this increase in survival rate is due to the apparently unique multifactorial influence of terlipressin over variceal haemostasis and blood flow, hepatic and gastric haemodynamics and renal function, combined with the likelihood of only minimal adverse events.