Addition of Simvastatin to Standard Therapy for the Prevention of Variceal Rebleeding Does Not Reduce Rebleeding but Increases Survival in Patients With Cirrhosis

Abraldes, Juan G.; Villanueva, Càndid; Aracil, Carles; Turnés, Juan; Hernández‐Guerra, Manuel; Genescà, Joan; García, Manuel Rodríguez; Castellote, José; García‐Pagán, Juan Carlos; Torres, Ferrán; Calleja, José Luís; Albillos, Agustı́n; Bosch, Jaime; Augustín, Salvador; Llop, Elba; Arraez, Dalia Morales; Mesa, Goretti Hernández; Martínez, Javier; Reverter, Enric; Seijó, Susana; Turón, Fanny; Miñana, Josep; Buenestado, J; Reñé, Josep Maria; Navacués, Carmen A.; Planas, Ramón; Morillas, Rosa; Bellot, Pablo; Such, José; Vergara, Mercedes; Puente, Ángela; Peña, Joaquín de la; Calviño, José Mera; Moral, Laura Rivas; Pavel, Oana; Alvarado, Edilmar; Ardèvol, Alba; Girbau, Anna; Cachero, Alba; Arnáiz, Joan Albert; Berzigotti, Annalisa; Pich, Judit; Ríos, J. W. Huamán; Saenz, R; Millán, Laura; Beleta, Helena; Ramos, Núria

doi:10.1053/j.gastro.2016.01.004

Cited by 262 publications

(291 citation statements)

References 52 publications

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“…In recent years, several new pharmacological strategies have been considered for the improved control of clinically significant PHT, with statins being best evaluated for their impact on PVP and survival in cirrhosis [85,86]. However, most drug candidates implicated in the control of PHT have not yet reached the human phase of investigation and we only have experimental evidence for their PVP lowering effects (Table 2).…”

Section: Therapeutic Perspectivesmentioning

confidence: 99%

Origins of Portal Hypertension in Nonalcoholic Fatty Liver Disease

Baffy

2018

Dig Dis Sci

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Section: Therapeutic Perspectivesmentioning

confidence: 99%

Origins of Portal Hypertension in Nonalcoholic Fatty Liver Disease

Baffy

2018

Dig Dis Sci

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“…A clinical study could not confirm an additional beneficial effect on top of the standard therapy on the risk of rebleeding, but an improved survival was observed [29] . Probably, a reduction in the bleeding-related mortality due to a better microcircula- tion and the attenuation of the liver inflammation in relation with the hemorrhage, resulted in a survival benefit.…”

Section: New Drugs To Improve Phmentioning

confidence: 91%

Novel Approaches to Reducing the Risk of Variceal Hemorrhage

Nevens

2017

Dig Dis

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Background: Complications of advanced liver disease occur at the moment of clinical significant portal hypertension. Nitric oxide (NO) dysfunction and fibrosis play an important role in the pathophysiology of PH, but other mechanisms are also involved. Non-selective beta blockers (NSBB) stay the cornerstone in the primary and secondary prevention of variceal bleeding, but their safety in advanced cirrhosis has been recently debated and new drugs are under investigation. Transjugular intrahepatic portosystemic shunt and balloon tamponade are the standard therapy in case of refractory variceal bleeding, but both interventions have drawbacks. Key Message: Transelastography under certain conditions and the presence of collateral circulation on imaging allow to rule-in CSPH, which makes patients open at risk for variceal hemorrhage. FXR agonists are intrahepatic NO donors; they reduce fibrosis and prevent bacterial translocation, which make them promising drugs for the treatment of PH. NSBB should be used with caution in patients with refractory ascites and certainly in those with hepatorenal syndrome. Preliminary clinical data suggest that simvastatin and enoxaparin improve the prognosis of patients with cirrhosis. Finally, covered esophageal metallic stents are safer and more effective than balloon tamponade in the case of refactory variceal bleeding. Conclusions: Liver stiffness measurements enable the selection of patients for endoscopic screening for esophageal varices. In the case of tense ascites, the dose of NSBB should be adapted to the hemodynamic condition of the patient. Self-expanding, covered esophageal metallic stents replace balloon tamponade in the treatment of massive variceal hemorrhage.

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“…Unfortunately, the authors did not mention the incidence of post EVL ulcer bleeding, and the incidence of rhabdomyolysis was higher than expected. [47] Somatostatin is a vasoconstrictor that is known for reducing portal pressure. A double-blind randomized controlled trial with 61 patients compared EVL plus somatostatin versus EVL plus placebo for controlling acute variceal bleeding.…”

Section: Other Drugsmentioning

confidence: 99%

Diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band ligation ulcer in cirrhotic patients

Lima

Silva

Romeiro

2018

CRIM

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Esophageal varices develop in half of cirrhotic patients. Endoscopic variceal band ligation is the current treatment for acute bleeding and applicable for primary and secondary prophylaxis. However, there is a risk of complications, including ligationinduced ulcer bleeding. The aim of this study is to review the current diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band-ligation ulcers in cirrhotic patients. PubMed and Google Scholar were searched for English language articles about the theme. The main findings were that Child-Pugh class C, higher model of end-stage liver disease, emergency ligation, presence of hepatocellular carcinoma, peptic esophagitis and bacterial infection were reported as the most important risk factors for post-banding ulcer hemorrhage. There are few studies with proton pump inhibitors and sucralfate showing size reduction of post-banding ulcers. Many treatment modalities have been used to control post band ulcer bleeding, such as band local injection of epinephrine or cyanoacrylate, balloon tamponade, stent placement and ligation of the ulcerated bleeding site. However, the optimal management remains uncertain. The principal conclusions of the study were that post-banding ulcer bleeding is potentially life-threatening and must be suspected in the presence of hematemesis, melena or anemia after endoscopic variceal band ligation (EVL). Predictors of rebleeding must be assessed and controlled as much as possible before band ligation. The post-banding treatment with proton pump inhibitors or sucralfate seems advisable, in particular for high-risk patients. Further investigation and new approaches are still required to achieve optimal management of this complication.

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Addition of Simvastatin to Standard Therapy for the Prevention of Variceal Rebleeding Does Not Reduce Rebleeding but Increases Survival in Patients With Cirrhosis

Cited by 262 publications

References 52 publications

Origins of Portal Hypertension in Nonalcoholic Fatty Liver Disease

Origins of Portal Hypertension in Nonalcoholic Fatty Liver Disease

Novel Approaches to Reducing the Risk of Variceal Hemorrhage

Diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band ligation ulcer in cirrhotic patients

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