Primary Prevention of Variceal Hemorrhage

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• 作者：Emmanuel A. Tsochatzis (1)
  Christos K. Triantos (1)
  Matteo Garcovich (1)
  Andrew K. Burroughs (1)
  
• 关键词：b ; blockers ; Band ligation ; Cirrhosis ; Bleeding ; Varices
• 刊名：Current Gastroenterology Reports
• 出版年：2011
• 出版时间：February 2011
• 年：2011
• 卷：13
• 期：1
• 页码：3-9
• 全文大小：169KB
• 参考文献：1. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W: Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007,46:922-938. CrossRef
  2. McCormick PA, O’Keefe C: Improving prognosis following a first variceal haemorrhage over four decades. Gut 2001,49:682-685. CrossRef
  3. -de Franchis R: Revising consensus in portal hypertension: Report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53:762-768. / The article describes the latest Baveno consensus on the management of portal hypertension.
  4. Burroughs AK, Thalheimer U: Hepatic venous pressure gradient in 2010: optimal measurement is key. Hepatology 2010,51:1894-1896.
  5. Groszmann RJ, Garcia-Tsao G, Bosch J, et al.: Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005,353:2254-2261. CrossRef
  6. D’Amico G, Garcia-Pagan JC, Luca A, Bosch J: Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology 2006,131:1611-1624. CrossRef
  7. -Manolakopoulos S, Triantos C, Theodoropoulos J, et al.: Antiviral therapy reduces portal pressure in patients with cirrhosis due to HBeAg-negative chronic hepatitis B and significant portal hypertension. J Hepatol 2009,51:468-474. / The article describes a proof-of-concept study on the effect of antiviral therapy in HVPG in patients with HBeAg-negative chronic hepatitis B.
  8. -Tsochatzis EA, Bosch J, Burroughs AK: Prolonging survival in patients with cirrhosis: old drugs with new indications. Gastroenterology 2010, doi:10.1053/j.gastro.2010.10.031. / This opinion paper discusses preventing the advent of complications in cirrhosis and thus prolonging survival.
  9. D’Amico G, Pagliaro L, Bosch J: The treatment of portal hypertension: a meta-analytic review. Hepatology 1995,22:332-354.
  10. Inokuchi K: Improved survival after prophylactic portal nondecompression surgery for esophageal varices: a randomized clinical trial. Cooperative Study Group of Portal Hypertension of Japan. Hepatology 1990,12:1-6.
  11. Pagliaro L, D’Amico G, Sorensen TI, et al.: Prevention of first bleeding in cirrhosis. A meta-analysis of randomized trials of nonsurgical treatment. Ann Intern Med 1992,117:59-70.
  12. -Triantos C, Goulis J, Burroughs AK: Portal hypertensive bleeding. In Evidence-Based Gastroenterology and Hepatology, edn 3. Edited by McDonald JWD, Burroughs AK, Feagan BG, Fennerty MB. Hoboken, NJ: Wiley-Blackwell; 2010:562-602. / This chapter presents a comprehensive analysis of available evidence in portal hypertensive bleeding.
  13. Poynard T, Cales P, Pasta L, et al.: Beta-adrenergic-antagonist drugs in the prevention of gastrointestinal bleeding in patients with cirrhosis and esophageal varices. An analysis of data and prognostic factors in 589 patients from four randomized clinical trials. Franco-Italian Multicenter Study Group. N Engl J Med 1991,324:1532-1538. CrossRef
  14. Abraczinskas DR, Ookubo R, Grace ND, et al.: Propranolol for the prevention of first esophageal variceal hemorrhage: a lifetime commitment? Hepatology 2001,34:1096-1102. CrossRef
  15. Perez-Ayuso RM, Pique JM, Bosch J, et al.: Propranolol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis. Lancet 1991,337:1431-1434. CrossRef
  16. -Garcia-Tsao G, Bosch J: Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med 2010,362:823-832. / The authors review the primary and secondary prevention of variceal bleeding.
  17. -Villanueva C, Aracil C, Colomo A, et al.: Acute hemodynamic response to beta-blockers and prediction of long-term outcome in primary prophylaxis of variceal bleeding. Gastroenterology 2009,137:119-128. / The article describes a prospective study of predicting the long-term effect of β-blockers by acute hemodymanic response.
  18. de-Madaria E, Palazon JM, Hernandez FT, et al.: Acute and chronic hemodynamic changes after propranolol in patients with cirrhosis under primary and secondary prophylaxis of variceal bleeding: a pilot study. Eur J Gastroenterol Hepatol 2010,22:507-512.
  19. La Mura V, Abraldes JG, Raffa S, et al.: Prognostic value of acute hemodynamic response to i.v. propranolol in patients with cirrhosis and portal hypertension. J Hepatol 2009,51:279-287. CrossRef
  20. Gluud LL, Klingenberg S, Nikolova D, Gluud C: Banding ligation versus beta-blockers as primary prophylaxis in esophageal varices: systematic review of randomized trials. Am J Gastroenterol 2007,102:2842-2848. CrossRef
  21. Tsochatzis EA, Triantos CK, Burroughs AK: Gastrointestinal bleeding: Carvedilol-the best beta-blocker for primary prophylaxis? Nat Rev Gastroenterol Hepatol 2009,6:692-694. CrossRef
  22. Wang HM, Lo GH, Chen WC, et al.: Comparison of endoscopic variceal ligation and nadolol plus isosorbide-5-mononitrate in the prevention of first variceal bleeding in cirrhotic patients. J Chin Med Assoc 2006,69:453-460. CrossRef
  23. -Tripathi D, Ferguson JW, Kochar N, et al.: Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed. Hepatology 2009,50:825-833. / This article describes the first randomized, controlled trial to show an advantage of β-blockers over band ligation in preventing the first variceal bleeding.
  24. -Burroughs AK, Tsochatzis EA, Triantos C: Primary prevention of variceal haemorrhage: a pharmacological approach. J Hepatol 2010,52:946-948. / This article is an opinion paper on the merits of β-blockers over band ligation for primary prophylaxis.
  25. Triantos C, Vlachogiannakos J, Manolakopoulos S, et al.: Is banding ligation for primary prevention of variceal bleeding as effective as beta-blockers, and is it safe? Hepatology 2006,43:196-197. CrossRef
  26. Lo GH, Chen WC, Lin CK, et al.: Improved survival in patients receiving medical therapy as compared with banding ligation for the prevention of esophageal variceal rebleeding. Hepatology 2008,48:580-587. CrossRef
  27. -Senzolo M, Cholongitas E, Burra P, et al.: beta-Blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis. Liver Int 2009, 29:1189-1193. / The authors report the possible effects of β-blockers in preventing spontaneous bacterial peritonitis in patients with cirrhosis.
  28. Merkel C, Marin R, Enzo E, et al.: Randomised trial of nadolol alone or with isosorbide mononitrate for primary prophylaxis of variceal bleeding in cirrhosis. Gruppo-Triveneto per L’ipertensione portale (GTIP). Lancet 1996,348:1677-1681. CrossRef
  29. Merkel C, Marin R, Sacerdoti D, et al.: Long-term results of a clinical trial of nadolol with or without isosorbide mononitrate for primary prophylaxis of variceal bleeding in cirrhosis. Hepatology 2000,31:324-329. CrossRef
  30. Garcia-Pagan JC, Morillas R, Banares R, et al.: Propranolol plus placebo versus propranolol plus isosorbide-5-mononitrate in the prevention of a first variceal bleed: a double-blind RCT. Hepatology 2003,37:1260-1266. CrossRef
  31. Gheorghe C, Gheorghe L, Iacob S, et al.: Primary prophylaxis of variceal bleeding in cirrhotics awaiting liver transplantation. Hepatogastroenterology 2006,53:552-557.
  32. Sarin SK, Wadhawan M, Agarwal SR, et al.: Endoscopic variceal ligation plus propranolol versus endoscopic variceal ligation alone in primary prophylaxis of variceal bleeding. Am J Gastroenterol 2005,100:797-804. CrossRef
  33. -Lo GH, Chen WC, Wang HM, Lee CC: Controlled trial of ligation plus nadolol versus nadolol alone for the prevention of first variceal bleeding. Hepatology 2010,52:230-237. / Combination therapy was not superior to nadolol alone in primary prevention of variceal bleeding in this randomized, controlled trial.
  34. -Abraldes JG, Albillos A, Banares R, et al.: Simvastatin lowers portal pressure in patients with cirrhosis and portal hypertension: a randomized controlled trial. Gastroenterology 2009,136:1651-1658. / Simvastatin administration significantly lowered HVPG after 1?month of administration over and above the effects of β-blockers in this randomized, controlled trial.
  35. -Tandon P, Abraldes JG, Berzigotti A, et al.: Renin-angiotensin-aldosterone inhibitors in the reduction of portal pressure: a systematic review and meta-analysis. J Hepatol 2010,53:273-282. / This article is a systematic review of the role of renin-angiotensin-aldosterone inhibitors in the reduction of portal pressure.
  36. -Mejias M, Garcia-Pras E, Tiani C, et al.: Beneficial effects of sorafenib on splanchnic, intrahepatic, and portocollateral circulations in portal hypertensive and cirrhotic rats. Hepatology 2009,49:1245-1256. / The authors describe an animal study on the beneficial effects of sorafenib in portal pressure in rats with cirrhosis.
  
• 作者单位：Emmanuel A. Tsochatzis (1)
  Christos K. Triantos (1)
  Matteo Garcovich (1)
  Andrew K. Burroughs (1)
  
  1. The Royal Free Sheila Sherlock Liver Centre and University Department of Surgery, Royal Free Hospital and UCL, Pond Street, Hampstead, London, NW3 2QG, UK
  

文摘

Variceal hemorrhage is one of the leading causes of death in patients with cirrhosis, with the 6-week mortality after each episode ranging from 15% to 20%. The two main strategies for primary prevention of variceal bleeding in patients with cirrhosis and varices are the administration of nonselective β-blockers or the obliteration of varices with use of endoscopic band ligation. In this review, we present and critically review the latest data on primary prevention of variceal hemorrhage. We advocate that nonselective β-blockers should be the first line therapy, and band ligation should be offered only in cases of intolerance or side effects. We also explore potential future therapies based on preliminary experimental and clinical data.