Propranolol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis

Pérez-Ayuso, Rosa María; Piqué, Josep M.; Bosch, Jaime; Quintero, Enrique; Valderrama, Rodrigo; Bordas, Josep M.; Rodés, Juan; Panés, Julián; Viver, Josep Maria; González, A.; Esteban, Rafael; Perez, Renata M.; Rodrigo, Luı́s; Rigau, Joaquim

doi:10.1016/0140-6736(91)93125-s

Cited by 253 publications

(117 citation statements)

References 24 publications

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“…receiving propranolol, patients reported signiicantly lower rates of rebleeding (38 vs. 65%) at 12 months and at 30 months (7 vs. 52%) compared with controls [67]. Similarly, a smaller study using a dose of 24-480 mg/day decreased the incidence of acute bleeding in 16 patients with PHG and also reduced the grade of PHG in 24 asymptomatic patients when given at a dose of 160 mg/day [68].…”

Section: Medical Treatmentmentioning

confidence: 90%

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Gastric Antral Vascular Ectasia and Portal Hypertensive Gastropathy

Ramai¹,

Linn²,

Reddy³

2018

Stomach Disorders

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Gastric antral vascular ectasia (GAVE) and portal hypertensive gastropathy (PHG) are mucosal lesions that can cause chronic gastrointestinal bleeding in the patients with cirrhosis. While PHG occurs exclusively in patients with liver cirrhosis, GAVE can also present in patients with systemic and autoimmune conditions. The need to accurately characterize these two conditions is dependent on clinical, endoscopic, and histological parameters. The management of GAVE utilizes endoscopic ablation techniques, while medical therapy is directed toward stabilizing portal pressure in patients with PHG. Herein, we review the epidemiology, diagnosis, pathophysiology, and medical, endoscopic, and surgical management of GAVE and PHG.

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Section: Medical Treatmentmentioning

confidence: 90%

“…Beta blockers are irst-line drugs used to reduce portal pressure and have the most beneit in patients with mild PHG [66]. Modest efects have been noted in patients with severe PHG [67]. It is unclear whether beta blockers are prophylactically efective in preventing bleeding from PHG [24].…”

Section: Medical Treatmentmentioning

confidence: 99%

Gastric Antral Vascular Ectasia and Portal Hypertensive Gastropathy

Ramai¹,

Linn²,

Reddy³

2018

Stomach Disorders

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Section: Antifibrotic Therapymentioning

confidence: 99%

“…Long-term propranolol treatment (12 and 30 months) was proven to reduce the frequency of rebleeding from severe portal hypertensive gastropathy [125]. Multivariate analysis showed that the absence of propranolol treatment was the only predictive variable for rebleeding [125]. The occurrence of portal hypertensive gastropathy after EVL for treatment of esophageal varices was significantly reduced by propranolol therapy [126].…”

Section: Antifibrotic Therapymentioning

confidence: 99%

Evidence-based clinical practice guidelines for liver cirrhosis 2015

et al. 2016

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The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V 2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for patients with acute-onset or progressive portal vein thrombosis.

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“…The NNT to prevent an additional episode of SBP was 8. In addition, NSBBs can protect against bleeding from portal hypertensive gastropathy by reducing cardiac output and inducing splachnic arterial vasoconstriction [30] , whereas endoscopic treatments have no effects on portal inflow or resistance.…”

Section: Nsbbs Vs No Interventionmentioning

confidence: 99%

Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis

Triantos

Kalafateli

2014

WJH

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Variceal bleeding is a life threatening situation with mortality rates of at least 20%. Prophylactic treatment with non-selective beta blockers (NSBBs) is recommended for patients with small varices that have not bled but with increased risk for bleeding. The recommended treatment strategies on primary prevention of variceal bleeding in patients with medium and largesized varices are NSBBs or endoscopic band ligation. Nitrates, shunt surgery and sclerotherapy are not recommended in this setting. In this review, the most recent data on prevention of esophageal variceal bleeding are presented. Available data derived from randomized-controlled trials suggest both treatment strategies, and according to Baveno V consensus in portal hypertension "the choice of treatment should be based on local resources and expertise, patient preference and characteristics, side-effects and contra-indications". Core tip: The significance of primary prevention of bleeding from esophageal varices in patients with liver cirrhosis is major, considering the high mortality rates that accompany the acute bleeding episode. Current management guidelines suggest the use of either nonselective beta-blockers or endoscopic band ligation with same efficacy between them. In this review, we summarize data from randomized clinical trials or prospective studies together with meta-analytical data, when applicable, to present the most updated recommendations on primary prevention of esophageal variceal bleeding.Triantos C, Kalafateli M. Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis.

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Propranolol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis

Cited by 253 publications

References 24 publications

Gastric Antral Vascular Ectasia and Portal Hypertensive Gastropathy

Gastric Antral Vascular Ectasia and Portal Hypertensive Gastropathy

Evidence-based clinical practice guidelines for liver cirrhosis 2015

Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis

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