A drug therapy for the prevention of variceal haemorrhage

Abstract

The development of varices is a major complication of cirrhosis, and variceal haemorrhage has a high mortality. There have been major advances in the primary and secondary prevention of variceal haemorrhage over the last 20 years involving endoscopic, radiological and pharmacological approaches. This review concentrates principally on drug therapy, particularly on the numerous haemodynamic studies. Many of these drugs have not been studied in clinical trials, but provide data about the underlying pathogenesis of portal hypertension. Also covered in this review are the randomized controlled trials and meta‐analyses that involve a large number of patients. These trials involve relatively few drugs such as non‐selective beta‐blockers and nitrates. Correlations between haemodynamic and clinical parameters are discussed. Despite the recent increase in the use of alternative endoscopic therapies, an effective and well tolerated drug remains a clinically important research goal.

High-Risk Esophageal Varices in Patients Treated with Locoregional Therapies for Hepatocellular Carcinoma: Evaluation with Regular Follow-Up Liver CT

“…Recently, physicians perform screening endoscopy to evaluate esophageal varices in cirrhotic patients [6,7]. Several studies have reported that further bleeding episodes were prevented following treatment with endoscopic variceal ligation (EVL) or the administration of b-blockers in patients with esophageal varices [2,3,8,9], and consequently, mortality of variceal bleeding in cirrhotic patients can be reduced [10]. It is debatable whether screening endoscopy to evaluate esophageal varices in cirrhotic patients is cost-effective for primary prophylaxis of variceal bleeding, because of the invasiveness and expensive cost of the procedure [11][12][13].…”

Esophageal Varices in Patients with Cirrhosis: Multidetector CT Esophagography—Comparison with Endoscopy

“…Results of several studies have demonstrated that the development or progression of esophageal varices can be treated successfully and further esophageal bleeding can be prevented by using ␤-blockers or endoscopic variceal ligation (2,4,7,8); consequently, the mortality of patients with cirrhosis can be reduced (9). There is a general consensus with regard to the viability of a strategy of screening endoscopy followed by prophylactic treatment of the varices (10).…”

Propranolol reduces variceal pressure and wall tension in schistosomiasis presinusoidal portal hypertension

“…The efficacy of propranolol in reducing portal pressure, and its surrogate markers variceal pressure and wall tension, is not well established in schistosomiasis, in contrast to liver cirrhosis in which a number of randomized controlled trials and meta‐analysis studies have demonstrated that the use of non‐selective β‐blockers in patients with medium and large varices is cost‐effective for preventing variceal rupture 5,6 …”

“…Although standard care for prevention of the first episode of variceal bleeding in cirrhotic patients is β‐blocker therapy, 5,6 this has not been demonstrated in schistosomiasis. This study was aimed at assessing the effect of propranolol on variceal pressure and wall tension of patients with schistosomiasis, high‐risk esophageal varices and no previous history of variceal hemorrhage.…”