Document Detail

Equal efficacy of endoscopic variceal ligation and propranolol in preventing variceal bleeding in patients with noncirrhotic portal hypertension.
MedLine Citation:
PMID:  20547163     Owner:  NLM     Status:  MEDLINE    
BACKGROUND & AIMS: Variceal bleeding increases morbidity and mortality among patients with noncirrhotic portal hypertension (NCPH). Blockers of β-adrenergic receptor signaling and endoscopic variceal ligation (EVL) have been used to prevent recurrence of bleeding, based on data from cirrhotic patients. We compared the efficacy and safety of the β-blocker propranolol with that of EVL in preventing the recurrence of variceal bleeding in patients with NCPH. METHODS: Consecutive patients with NCPH with a history of variceal bleeding in the past 6 weeks were assigned randomly to groups treated every 3 weeks with EVL (n = 51) or propranolol (until they had a resting heart rate of 55 beats per minute or to a maximum of 320 mg/day; n = 50). Primary end points were recurrence of variceal bleeding or death. Secondary end points were complications of EVL in patients given EVL, variceal eradication after EVL, variceal recurrence after EVL, or a decrease in variceal grade in patients given propranolol. RESULTS: After a median follow-up period of 23 months, rates of recurrence of bleeding were similar between the groups (EVL, 23.5%; propranolol, 18%; P = .625). The actuarial probability of remaining free of bleeding recurrence was similar between the groups. No deaths occurred in either group. Of the patients given propranolol, 47% had a decrease in the grade of varices and none experienced bleeding. Adverse events were minor and comparable between groups (EVL, 12%; propranolol, 18%; P = .635). CONCLUSIONS: EVL was not more effective than the β-blocker propranolol for the secondary prophylaxis of variceal bleeding in patients with NCPH.
Shiv Kumar Sarin; Nitin Gupta; Sanjeev Kumar Jha; Amit Agrawal; Smruti Ranjan Mishra; Barjesh Chander Sharma; Ashish Kumar
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2010-06-12
Journal Detail:
Title:  Gastroenterology     Volume:  139     ISSN:  1528-0012     ISO Abbreviation:  Gastroenterology     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-04     Completed Date:  2010-10-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1238-45     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.
Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use*
Child, Preschool
Esophageal and Gastric Varices / therapy*
Gastrointestinal Hemorrhage / prevention & control*
Hypertension, Portal / complications*
Propranolol / therapeutic use*
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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