Non-steroidal anti-inflammatory drugs and variceal bleeding: a case-control study

Lédinghen, Victor de; Mannant, P.-R.; Foucher, Juliette; Perault, M. C.; Barrioz, Thierry; Ingrand, Pierre; Vandel, B; Silvain, Christine; Beauchant, Michel

doi:10.1016/s0168-8278(96)80142-5

Cited by 21 publications

(19 citation statements)

References 19 publications

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“…Th is study used a standard questionnaire to assess Valsalva maneuver-related activities including constipation ( 15 ), vomiting ( 16 ), and cough ( 17 ), and also assess alcohol consumption ( 18 ) and use of NSAID ( 13,14 ) in the week preceding inclusion in the study. A trained study nurse, who was blinded to the results of the endoscopy, met all subjects within 24 h post-endoscopy to provide instructions to complete the questionnaire.…”

Section: Data Collectionmentioning

confidence: 99%

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Potential Precipitating Factors of Esophageal Variceal Bleeding: A Case–Control Study

Liao

Hou

Chang

et al. 2011

American Journal of Gastroenterology

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Valsalva maneuver-associated activities such as straining during defecation, vomiting, and cough are believed to cause abrupt increase in variceal pressure. Whether these actions can precipitate rupture of esophageal varices (EV) is unknown. The association of EV bleeding with these activities and other potential risk factors such as ingestion of alcohol and non-steroidal anti-infl ammatory drugs was investigated. METHODS:Between January 2003 and May 2009, 240 patients with liver cirrhosis and acute EV bleeding (group A) and 240 matched patients with Child-Pugh ' s class and moderate size EV without bleeding (group B) were included. Each patient was questioned regarding constipation, vomiting, cough, and other potential risk factors in the week prior to index bleeding (group A) or endoscopy (group B) using a standard questionnaire. RESULTS:Group A had more patients with constipation ( n = 44 vs. n = 16, P < 0.001) and higher constipation scores (0.79 ± 1.67 vs. 0.25 ± 0.92, P < 0.001) than group B. Group A also had more patients with vomiting ( n = 60 vs. n = 33, P = 0.002) and higher vomiting scores (3.0 ± 0.86 vs. 1.85 ± 0.87, P < 0.001). No difference in cough existed between the two groups ( n = 77 group A vs. n = 73 group B); however, group A had higher cough scores (5.08 ± 2.70 vs. 3.19 ± 2.23, P < 0.001). Group A had more patients with excessive alcohol consumption in the week preceding inclusion in the study ( n = 58 vs. n = 5, P < 0.001). On multivariate analysis, constipation score and vomiting score and alcohol consumption were independent determinants of fi rst EV bleeding.CONCLUSIONS: Constipation, vomiting, severe coughing, and excessive consumption of alcohol may precipitate rupture of EV. A prospective cohort study is required to clarify the causal relationship between potential precipitating factors and EV bleeding.

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Section: Data Collectionmentioning

confidence: 99%

“…Isometric exercise ( 10,11 ) and heavy alcohol binges ( 12 ) reportedly increase portal pressure. Ingestion of aspirin or other non-steroidal anti-infl ammatory drugs (NSAIDs) is also associated with EV bleeding ( 13,14 ).…”

Section: Introductionmentioning

confidence: 99%

Potential Precipitating Factors of Esophageal Variceal Bleeding: A Case–Control Study

Liao

Hou

Chang

et al. 2011

American Journal of Gastroenterology

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“…Pharmacologic drugs might influence the risk of variceal bleeding [41][42][43][44]. Two previous interview-based studies [41,42] had demonstrated that aspirin, used alone or in combination with other nonsteroidal anti-inflammatory drugs, was significantly associated with first variceal bleeding episode in patients with cirrhosis.…”

Section: Recommendationsmentioning

confidence: 99%

“…Two previous interview-based studies [41,42] had demonstrated that aspirin, used alone or in combination with other nonsteroidal anti-inflammatory drugs, was significantly associated with first variceal bleeding episode in patients with cirrhosis. Therefore, it was suggested, given the life-threatening nature of variceal bleed, that the possible benefit of aspirin treatment should be weighed against the risk of this complication.…”

Section: Recommendationsmentioning

confidence: 99%

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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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Short‐Term Safety of Repeated Acetaminophen Use in Patients With Compensated Cirrhosis

et al. 2021

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Current guidelines recommend restricting acetaminophen (APAP) use in patients with cirrhosis, but evidence to support that recommendation is lacking. Prior studies focused on pharmacokinetics (PK) of APAP in cirrhosis but did not rigorously examine clinical outcomes, sensitive biomarkers of liver damage, or serum APAP-protein adducts, which are a specific marker of toxic bioactivation. Hence, the goal of this pilot study was to test the effects of regularly scheduled APAP dosing in a well-defined compensated cirrhosis group compared to control subjects without cirrhosis, using the abovementioned outcomes. After a 2-week washout, 12 subjects with and 12 subjects without cirrhosis received 650 mg APAP twice per day (1.3 g/day) for 4 days, followed by 650 mg on the morning of day 5. Patients were assessed inperson at study initiation (day 1) and on days 3 and 5. APAP-protein adducts and both conventional (alanine aminotransferase) and sensitive (glutamate dehydrogenase [GLDH], full-length keratin 18 [K18], and total high-mobility group box 1 protein) biomarkers of liver injury were measured in serum on the mornings of days 1, 3, and 5, with detailed PK analysis of APAP, metabolites, and APAP-protein adducts throughout day 5. No subject experienced adverse clinical outcomes. GLDH and K18 were significantly different at baseline but did not change in either group during APAP administration. In contrast, clearance of APAP-protein adducts was dramatically delayed in the cirrhosis group. Minor differences for other APAP metabolites were also detected. Conclusion: Short-term administration of lowdose APAP (650 mg twice per day, <1 week) is likely safe in patients with compensated cirrhosis. These data provide a foundation for future studies to test higher doses, longer treatment, and subjects who are decompensated, especially in light of the remarkably delayed adduct clearance in subjects with cirrhosis. (Hepatology Communications 2021;0:1-13).A cetaminophen (APAP) is the most commonly used analgesic in the United States and throughout much of the world. However, overdose of APAP causes massive centrilobular hepatocyte necrosis that can lead to acute liver failure (ALF) and death. It is overwhelmingly the most common cause of drug-induced ALF in the United States and similarly developed countries, accounting for at least 45%-65% of all cases (1) and possibly even more that go undiagnosed. (2) Although mortality is generally lower in APAP-induced ALF compared to other etiologies, the large number of cases makes APAP overdose the most common cause of ALF-related deaths as well.

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Non-steroidal anti-inflammatory drugs and variceal bleeding: a case-control study

Cited by 21 publications

References 19 publications

Potential Precipitating Factors of Esophageal Variceal Bleeding: A Case–Control Study

Potential Precipitating Factors of Esophageal Variceal Bleeding: A Case–Control Study

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

Short‐Term Safety of Repeated Acetaminophen Use in Patients With Compensated Cirrhosis

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