Document Detail

Primary prophylaxis of variceal bleeding in cirrhotic patients: a cohort study.
MedLine Citation:
PMID:  18468499     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Current guidelines recommend beta-blockers for primary prevention of variceal haemorrhage in cirrhotic patients, and band ligation for patients with contraindications or intolerance to beta-blockers. However, it has been suggested that these patients may respond poorly to band ligation. AIM: We evaluated the usefulness of a strategy in which band ligation was used to treat patients with contraindications or intolerance and patients not responding to beta-blockers identified by hepatic vein pressure gradient measurement. Haemodynamic responders and patients refusing hepatic vein pressure gradient measurement were given long-term beta-blockers. METHODS: One hundred and thirty-five consecutive patients with high-risk oesophageal varices and no prior bleeding were enrolled. Twenty-five patients with contraindications (group A), 26 with intolerance to beta-blockers (group B) and 25 showing a poor haemodynamic response (Group C) underwent band ligation. Twenty-two haemodynamic responders (Group D) and 37 refusing hepatic vein pressure gradient measurement (Group E) were treated with beta-blockers. RESULTS: Median follow-up was 32 months. 12/135 patients (8.9%) bled: 3/25 (12%) in group A, 1/26 (3.8%) in group B, 0/25 (0%) in group C, 0/22 (0%) in group D and 8/37 (22.2%) in group E. Mortality was 8/135 (5.9%). CONCLUSIONS: Patients with contraindications, intolerance or not responding to beta-blockers treated with band ligation achieve protection from variceal bleeding comparable to that of good responders to beta-blockers.
A Dell'Era; J Cubero Sotela; F M Fabris; G Petazzi; R Reati; F Iannuzzi; A Nicolini; M G Rumi; R de Franchis; M Primignani
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Publication Detail:
Type:  Journal Article     Date:  2008-05-08
Journal Detail:
Title:  Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver     Volume:  40     ISSN:  1878-3562     ISO Abbreviation:  Dig Liver Dis     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-14     Completed Date:  2009-03-25     Revised Date:  2009-05-20    
Medline Journal Info:
Nlm Unique ID:  100958385     Medline TA:  Dig Liver Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  936-43     Citation Subset:  IM    
Department of Medical Sciences, University of Milan, IRCCS Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena Foundation, Milan, Italy.
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MeSH Terms
Adrenergic beta-Antagonists / adverse effects,  contraindications
Esophageal and Gastric Varices / drug therapy,  etiology,  surgery*
Follow-Up Studies
Gastrointestinal Hemorrhage / prevention & control*
Liver Cirrhosis / complications*
Middle Aged
Reg. No./Substance:
0/Adrenergic beta-Antagonists

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