Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature

Abstract

All patients with liver cirrhosis and portal hypertension should be stratified by risk groups to individualize different therapeutic strategies to increase the effectiveness of treatment. In this regard, the development of primary prophylaxis of variceal bleeding and its management according to the severity of portal hypertension may be promising. This paper is to describe the modern principles of primary prophylaxis of esophageal variceal bleeding in patients with liver cirrhosis. The PubMed and EMbase databases, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews were used to search for relevant publications from 1999 to 2019. The results suggested that depending on the severity of portal hypertension, patients with cirrhosis should be divided into those who need preprimary prophylaxis, which aims to prevent the formation of esophageal varices, and those who require measures that aim to prevent esophageal variceal bleeding. In subclinical portal hypertension, therapy should be etiological and pathogenetic. Cirrhosis with clinically significant portal hypertension should receive nonselective β‐blockers if they have small esophageal varices and risk factors for variceal bleeding. Nonselective β‐blockers are the first‐line drugs for the primary prevention of bleeding from medium to large‐sized esophageal varices. Endoscopic band ligation is indicated for the patients who are intolerant to nonselective β‐blockers or in the case of contraindications to pharmacological therapy. In summary, the stratification of cirrhotic patients by the severity of portal hypertension and an individual approach to the choice of treatment may increase the effectiveness of therapy as well as improve survival rate of these patients.

Diagnostic Value of Non-invasive Scoring Systems in the Prediction of Esophageal Varices in Patients with Liver Cirrhosis—Single Center Experience

“…These limitations have contributed to the development of alternative methods of assessing PH severity. Several biochemical tests and serum concentrations of inflammatory biomarkers, as well as imaging techniques, have been reported to correlate with CSPH [2]. Adequate diagnosis of PH is important, however early diagnosis of subclinical PH is even more important, because of the preprimary prophylaxes that include etiotropic and pathogenetic treatment.…”

Elastography as a predictor of liver cirrhosis complications after hepatitis C virus eradication in the era of direct-acting antivirals

“…The review by Garbuzenko et al [ 38 ] confirmed that staging the severity of PH in cirrhotic subjects and personalized preventive therapy could lead to an increase in both patient survival and treatment effectiveness; particularly, DAAs achieve the amelioration of subclinical PH. In a recent study by Afdhal et al [ 39 ] of 50 patients with clinically significant PH (presence of esophageal varices, HVPG > 6 mmHg) from different international centers, 89% obtained a HVPG reduction of > 20% and only 3 patients obtained a reduction of portal pressure to less than 12 mmHg.…”

The role of antiviral therapy in the management of patients with liver cirrhosis associated with chronic HBV and HCV infection

“…ассоциированном с хронической HBVи HCV-инфекцией За последние годы установлено, что УВО при ассоциированном с хронической HBV-и HCV-инфекцией ЦП позитивно влияет не только на гистологическую структуру печени, но и на динамику ПГ [44]. Например, S. Manolakopoulos и соавт.…”