Isosorbide mononitrate in the prevention of first variceal bleed in patients who cannot receive β-blockers

García‐Pagán, Juan Carlos; Villanueva, Carmen Navarro; Vila, María; Albillos, Agustı́n; Genescà, Joan; Ruíz-del-Árbol, Luís; Planas, Ramón; Rodríguez, Manuel; Calleja, José Luís; González, Antonio; Solá, Ricard; Balanzó, Joaquím; Bosch, Jaume

doi:10.1053/gast.2001.27993

Cited by 45 publications

(42 citation statements)

References 26 publications

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“…79 In fact, in a recent multicenter trial, 133 cirrhotic patients with varices and contraindications or intolerance to ␤-blockers were randomized to ISMN (n ϭ 67) or to placebo (n ϭ 66). 80 Surprisingly, there was a greater 1-and 2-year probability of first variceal hemorrhage in the ISMN group (p ϭ 0.056), with no differences in survival. Side effects were more frequent in patients receiving ISMN.…”

Section: Therapies Not Recommended For Primary Prophylaxismentioning

confidence: 88%

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

et al. 2007

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Section: Therapies Not Recommended For Primary Prophylaxismentioning

confidence: 88%

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

et al. 2007

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“…45 Propranolol cannot be used in all cirrhotic patients and is also known to sometimes have severe adverse effects in cirrhotic patients. 46 Conjugated bile acids may provide an alternative to antibiotic prophylaxis for SBP. Cholylsarcosine has been used in patients with cholestatic liver disease 47 as well as to promote lipid absorption in short bowel syndrome.…”

Section: Discussionmentioning

confidence: 99%

Oral Bile Acids Reduce Bacterial Overgrowth, Bacterial Translocation, and Endotoxemia in Cirrhotic Rats

et al. 2003

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Experiments were performed to test whether conjugated bile acid administration would decrease bacterial overgrowth, bacterial translocation, and endotoxemia in ascitic cirrhotic rats. Cholylsarcosine, a deconjugation-dehydroxylation resistant and cholylglycine, a deconjugation-dehydroxylation susceptible bile acid were used. Rats with CCl 4 -induced cirrhosis and ascites were fed cholylsarcosine, cholylglycine (both at 70 mg/kg/d), or placebo for 2 weeks. Healthy rats, as controls, were treated similarly. In cirrhotic rats receiving placebo, bile secretion from an acute biliary fistula was lower than in healthy rats (27.2 ؎ 6.5 vs. 53.0 ؎ 3.1 L/kg/min; mean ؎ SE, P < .05). The administration of conjugated bile acids to cirrhotic rats normalized bile secretion (cholylsarcosine, 51.8 ؎ 6.29; cholylglycine, 52.72 ؎ 8.9 L/kg/min). Total ileal bacterial content was 6-fold higher in ascitic cirrhotic rats than in healthy rats. Conjugated bile acid administration reduced bacterial content to normal levels. Bacterial translocation was less in cirrhotic animals receiving conjugated bile acids (cholylsarcosine, 33%; cholylglycine, 26%) than in animals receiving placebo (66%). Endotoxemia was decreased in cirrhotic rats by conjugated bile acid feeding (cholylsarcosine, 0.098 ؎ 0.002; cholylglycine 0.101 ؎ 0.007 EU/mL) compared with placebo (0.282 ؎ 0.124, P < .001). Survival was greater in animals receiving conjugated bile acids (cholylsarcosine, 10/15; cholylglycine, 11/15; placebo, 5/15). In conclusion, the administration of conjugated bile acids to ascitic cirrhotic rats increased bile acid secretion, eliminated intestinal bacterial overgrowth, decreased bacterial translocation, decreased endotoxemia, and increased survival. Oral conjugated bile acids may be useful in preventing bacterial translocation, endotoxemia, and spontaneous bacterial perotonitis in cirrhotic patients. (HEPATOLOGY 2003;37:551-557.)

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“…Previous trials reporting on the pharmacologic prophylaxis of small esophageal varices have included a total of 179 patients. Heterogeneity in both the classification of varices and the number of bleeding episodes in this subgroup is small [20][21][22][23][24][25][26]. The only two available studies, specifically addressing the issue of the efficacy of nonselective b-blockers in preventing the enlargement of small varices, have contradictory results.…”

Section: Recommendationsmentioning

confidence: 99%

“…Subsequent trials in patients who were intolerant to b-blockers showed that ISMN increased the risk of bleeding at 1 and 2 years compared with patients receiving no treatment, although this did not affect survival. Furthermore, adverse effects were more frequent in patients receiving ISMN [23,72]. Therefore, it was concluded that nitrates alone should not be used in patients with cirrhosis for primary prophylaxis.…”

Section: Recommendationsmentioning

confidence: 99%

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

et al. 2008

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The Asian Pacific Association for the Study of the Liver (APASL) set up a Working Party on Portal Hypertension in 2002, with a mandate to develop consensus guidelines on various clinical aspects of portal hypertension relevant to disease patterns and clinical practice in the Asia-Pacific region. Variceal bleeding is a consequence of portal hypertension, which, in turn, is the major complication of liver cirrhosis. Primary prophylaxis to prevent the first bleed from varices is one of the most important strategies for reducing the mortality in cirrhotic patients. Experts predominantly from the Asia-Pacific region were requested to identify the different aspects of primary prophylaxis and develop the consensus guidelines. The APASL Working Party on Portal Hypertension evaluated the various therapies that have been used for the prevention of first variceal bleeding. A 2-day meeting was held on January 12 and 13, 2007, at New Delhi, India, to discuss and finalize the consensus statements. Only those statements that were unanimously approved by the experts were accepted. These statements were circulated to all the experts and were subsequently presented at the annual conference of the APASL at Kyoto, Japan, in March 2007.

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Isosorbide mononitrate in the prevention of first variceal bleed in patients who cannot receive β-blockers

Cited by 45 publications

References 26 publications

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

Oral Bile Acids Reduce Bacterial Overgrowth, Bacterial Translocation, and Endotoxemia in Cirrhotic Rats

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

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