| Primary prophylaxis of variceal bleeding in cirrhotic patients: a cohort study. | |
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MedLine Citation:
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PMID: 18468499 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article Date: 2008-05-08 |
Journal Detail:
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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:
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Created Date: 2008-11-14 Completed Date: 2009-03-25 Revised Date: 2009-05-20 |
Medline Journal Info:
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Nlm Unique ID: 100958385 Medline TA: Dig Liver Dis Country: Netherlands |
Other Details:
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Languages: eng Pagination: 936-43 Citation Subset: IM |
Affiliation:
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Department of Medical Sciences, University of Milan, IRCCS Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena Foundation, Milan, Italy. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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adverse effects,
contraindications Endoscopy* Esophageal and Gastric Varices / drug therapy, etiology, surgery* Female Follow-Up Studies Gastrointestinal Hemorrhage / prevention & control* Humans Ligation Liver Cirrhosis / complications* Male Middle Aged |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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