Document Detail


Prevention of first upper gastrointestinal bleeding in cirrhosis.
MedLine Citation:
PMID:  16498354     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
Variceal bleeding due to portal hypertension, is a major complication of hepatic cirrhosis. There is a high mortality rate after first bleeding so that primary prophylaxis to prevent bleeding from varices and portal hypertensive gastropathy is the current optimal therapeutic approach. The difficulty in identifying individual patients with varices who will bleed before they do so, can justify a strategy of prophylactic treatment for all patients with varices. We have evaluated the different therapies that have been assessed in randomized controlled trials for prevention of first bleeding, using meta-analysis where applicable. The current treatment of first choice is non-selective beta-blockers; it is cheap, easy to administer, and is effective in preventing the first variceal hemorrhage and bleeding from gastric mucosa. Combination drug therapy of beta-blockers and nitrates probably gives little added advantage. Injection sclerotherapy is contraindicated. The conflicting results of the randomized studies of endoscopic banding ligation, as well as its cost, do not warrant its use at present. However, endoscopic banding ligation may be a reasonable alternative for patients who cannot tolerate, or have contraindications to beta-blockers or no haemodynamic response to the drug therapy, but this must be proved in randomized trials.
Authors:
J Vlachogiannakos; P Montalto; A K Burroughs
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Minerva gastroenterologica e dietologica     Volume:  46     ISSN:  1121-421X     ISO Abbreviation:  Minerva Gastroenterol Dietol     Publication Date:  2000 Jun 
Date Detail:
Created Date:  2006-02-24     Completed Date:  2006-03-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9109791     Medline TA:  Minerva Gastroenterol Dietol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  87-98     Citation Subset:  -    
Affiliation:
Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital--London, UK.
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