No abstract

In a randomized controlled trial, addition of simvastatin to standard therapy did not reduce rebleeding, but was associated with a survival benefit for patients with Child-Pugh class A or B cirrhosis. Survival was not the primary end point of the study, so these results require validation. The incidence of rhabdomyolysis in patients receiving 40 mg/d simvastatin was higher than expected. European Clinical Trial Database ID: EUDRACT 2009-016500-24; ClinicalTrials.gov ID: NCT01095185.

No abstract

These findings show a high prevalence of silent liver disease with advanced fibrosis mainly related to NAFLD in adult European subjects without known liver disease. An LS value less than 9.2 kPa predicts the absence of significant liver fibrosis with high accuracy and could be used for screening purposes.

; for the Variceal Bleeding Study GroupBalloon tamponade is recommended only as a "bridge" to definitive therapy in patients with cirrhosis and massive or refractory esophageal variceal bleeding (EVB), but is frequently associated with rebleeding and severe complications. Preliminary, noncontrolled data suggest that a self-expandable, esophageal covered metal stent (SX-ELLA Danis; Ella-CS, Hradec Kralove, Czech Republic) may be an effective and safer alternative to balloon tamponade. We conducted a randomized, controlled trial aimed at comparing esophageal stent versus balloon tamponade in patients with cirrhosis and EVB refractory to medical and endoscopic treatment. Primary endpoint was success of therapy, defined as survival at day 15 with control of bleeding and without serious adverse events (SAEs). Twenty-eight patients were randomized to Sengstaken-Blakemore tube (n 5 15) or SX-ELLA Danis stent (n 5 13). Patients were comparable in severity of liver failure, active bleeding at endoscopy, and initial therapy. Success of therapy was more frequent in the esophageal stent than in balloon tamponade group (66% vs. 20%; P 5 0.025). Moreover, control of bleeding was higher (85% vs. 47%; P 5 0.037) and transfusional requirements (2 vs 6 PRBC; P 5 0.08) and SAEs lower (15% vs. 47%; P 5 0.077) in the esophageal stent group. TIPS was used more frequently in the tamponade group (4 vs. 10; P 5 0.12). There were no significant differences in 6-week survival (54% vs. 40%; P 5 0.46). Conclusion: Esophageal stents have greater efficacy with less SAEs than balloon tamponade in the control of EVB in treatment failures. Our findings favor the use of esophageal stents in patients with EVB uncontrolled with medical and endoscopic treatment. (HEPATOLOGY 2016;63:1957-1967 SEE EDITORIAL ON PAGE 1768A cute bleeding from esophageal varices (AVB) carries a death rate ranging from 12% to 20% during the acute episode, which, by consensus, is defined as the first 5 days after the patient reaches the hospital.(1-3) Failure to control bleeding or early rebleeding leads to a very high mortality, ranging from 30% to 50%, suggesting that failure of initial treatment should be considered a strong predictor of mortality in patients with AVB. (2)(3)(4)(5) Treatment for AVB according to current guidelines is based on early and cautious blood volume resuscitation, early administration of IV vasoactive drugs (terlipressin, somatostatin, or analogs) and of prophylactic

The LeVeen shunt and paracentesis are equally effective in relieving refractory ascites. The former may provide better long-term control of ascites, but shunt occlusion is common and survival is not improved.

Background and aims: Previous clinical trials suggest that adding non-selective beta-blockers improves the efficacy of endoscopic band ligation (EBL) in the prevention of recurrent bleeding, but no study has evaluated whether EBL improves the efficacy of betablockers + isosorbide-5-mononitrate. The present study was aimed at evaluating this issue in a multicentre randomised controlled trial (RCT) and to correlate changes in hepatic venous pressure gradient (HVPG) during treatment with clinical outcomes Methods: 158 patients with cirrhosis, admitted because of variceal bleeding, were randomised to receive nadolol+isosorbide-5-mononitrate alone (Drug: n = 78) or combined with EBL (Drug+EBL; n = 80). HVPG measurements were performed at randomisation and after 4-6 weeks on medical therapy.

No abstract