Document Detail


Acute and chronic hemodynamic changes after propranolol in patients with cirrhosis under primary and secondary prophylaxis of variceal bleeding: a pilot study.
MedLine Citation:
PMID:  20150817     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM: Prophylactic treatment of variceal bleeding in cirrhotic patients with beta-blockers is effective in only some patients. Our aim was to determine whether the response of the hepatic venous pressure gradient (HVPG) to the intravenous administration of propranolol predicts the response after chronic oral propranolol treatment. PATIENTS AND METHODS: We included prospectively cirrhotic patients with esophageal varices under primary prophylaxis (PP) and secondary prophylaxis (SP). The HVPG was measured at baseline and after a propranolol bolus (0.15 mg/kg intravenous). A patient was considered a good-responder if HVPG decreased to 12 mmHg or 20% from baseline. Patients then received oral propranolol (heart rate titrated). Poor-responders under SP were also included in a variceal band ligation program. After at least 3 months, a second hemodynamic study was conducted. RESULTS: Fifty-six patients were included (36 SP and 20 PP). Response rate was similar (32.1 and 41.9%, P=0.7) and the Pearson's correlation coefficient was 0.61 (P=0.001). In 81.4% patients, the first study predicted the response status of the second. Six patients rebled on follow-up between the studies, all of them were poor responders to intravenous propranolol. CONCLUSION: A single hemodynamic study using intravenous propranolol seems to predict chronic response to propranolol.
Authors:
Enrique de-Madaria; José María Palazón; Flavia Tamara Hernández; José Sánchez-Paya; Pedro Zapater; Javier Irurzun; Francisco de España; Sonia Pascual; José Such; Laura Sempere; Fernando Carnicer; Antonio García-Herola; Jaime Valverde; Miguel Pérez-Mateo
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of gastroenterology & hepatology     Volume:  22     ISSN:  1473-5687     ISO Abbreviation:  Eur J Gastroenterol Hepatol     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-15     Completed Date:  2010-07-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9000874     Medline TA:  Eur J Gastroenterol Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  507-12     Citation Subset:  IM    
Affiliation:
Unidad hepática, Hospital General Universitario de Alicante, Alicante, Spain.
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Adrenergic beta-Antagonists / administration & dosage*
Esophageal and Gastric Varices / drug therapy*,  etiology*,  prevention & control
Female
Follow-Up Studies
Heart Rate / drug effects
Humans
Injections, Intravenous
Liver Cirrhosis / complications*
Male
Middle Aged
Pilot Projects
Predictive Value of Tests
Propranolol / administration & dosage*
Prospective Studies
Treatment Outcome
Venous Pressure / drug effects
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 525-66-6/Propranolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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