A placebo-controlled clinical trial of nadolol in the prophylaxis of growth of small esophageal varices in cirrhosis

Merkel, Carlo; Marin, R.; Angeli, Paolo; Zanella, Pierluigi; Felder, Martina; Bernardinello, Elisabetta; Cavallarin, Giorgio; Bolognesi, Massimo; Donada, Carlo; Bellini, Barbara; Torboli, Pierluigi; Gatta, Angelo

doi:10.1053/j.gastro.2004.05.004

Cited by 244 publications

(44 citation statements)

References 26 publications

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“…However, in some countries both accessibility to endoscopy and resources may be limited [11][12][13], and these limitations together with the everincreasing workload on endoscopy units emphasises the need for simple and commonly available parameters that can non-invasively diagnose EV [14][15][16][17]. In many studies, thrombocytopenia was the factor most commonly associated with varices, though it lacked adequate accuracy, likely due to a multifactorial aetiology [18,19].…”

Section: Introductionmentioning

confidence: 99%

External Validation of the Platelet Count/Spleen Diameter Ratio for the Diagnosis of Esophageal Varices in Hepatitis C Virus-Related Cirrhosis

et al. 2008

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Section: Introductionmentioning

confidence: 99%

External Validation of the Platelet Count/Spleen Diameter Ratio for the Diagnosis of Esophageal Varices in Hepatitis C Virus-Related Cirrhosis

et al. 2008

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“…The factors associated to the growth of small varices are decompensated liver cirrhosis (Child-Pugh class B or C), alcoholic etiology of cirrhosis and the presence of red wale marks at initial endoscopy [4] . The efficacy of NSBBs on preventing the progression of small to large varices is debated [16,17] . In a randomized double-blind controlled trial [16] aiming to evaluate propranolol in the prevention of the development of large varices in patients with cirrhosis and small or no varices, 102 patients were randomized to receive propranolol (160 mg/d) and 104 to receive a placebo.…”

Section: Pre-primary Prophylaxismentioning

confidence: 99%

“…However, one third of patients were lost to follow-up after 2 years. In a placebo-controlled trial [17] , 161 patients with cirrhosis and small esophageal varices were randomized to nadolol (n = 83) or placebo (n = 78). The dose of nadolol was adjusted to decrease heart rate by 25%.…”

Section: Pre-primary Prophylaxismentioning

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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“…Previous trials reporting on the pharmacologic prophylaxis of small esophageal varices have included a total of 179 patients. Heterogeneity in both the classification of varices and the number of bleeding episodes in this subgroup is small [20][21][22][23][24][25][26]. The only two available studies, specifically addressing the issue of the efficacy of nonselective b-blockers in preventing the enlargement of small varices, have contradictory results.…”

Section: Recommendationsmentioning

confidence: 99%

“…However, the study enrolled patients with no and small varices, and a large number of the patients failed to have a regular follow-up. Another large multicenter, placebocontrolled, but single-blinded trial by Merkel et al [26] showed that patients with small varices treated with nadolol had a significantly slower progression to large varices (11% at 3 years) than patients who were randomized to placebo (37% at 3 years), with no differences in survival. These encouraging results are in clear contrast to the previous study.…”

Section: Recommendationsmentioning

confidence: 99%

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

et al. 2008

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The Asian Pacific Association for the Study of the Liver (APASL) set up a Working Party on Portal Hypertension in 2002, with a mandate to develop consensus guidelines on various clinical aspects of portal hypertension relevant to disease patterns and clinical practice in the Asia-Pacific region. Variceal bleeding is a consequence of portal hypertension, which, in turn, is the major complication of liver cirrhosis. Primary prophylaxis to prevent the first bleed from varices is one of the most important strategies for reducing the mortality in cirrhotic patients. Experts predominantly from the Asia-Pacific region were requested to identify the different aspects of primary prophylaxis and develop the consensus guidelines. The APASL Working Party on Portal Hypertension evaluated the various therapies that have been used for the prevention of first variceal bleeding. A 2-day meeting was held on January 12 and 13, 2007, at New Delhi, India, to discuss and finalize the consensus statements. Only those statements that were unanimously approved by the experts were accepted. These statements were circulated to all the experts and were subsequently presented at the annual conference of the APASL at Kyoto, Japan, in March 2007.

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A placebo-controlled clinical trial of nadolol in the prophylaxis of growth of small esophageal varices in cirrhosis

Cited by 244 publications

References 26 publications

External Validation of the Platelet Count/Spleen Diameter Ratio for the Diagnosis of Esophageal Varices in Hepatitis C Virus-Related Cirrhosis

External Validation of the Platelet Count/Spleen Diameter Ratio for the Diagnosis of Esophageal Varices in Hepatitis C Virus-Related Cirrhosis

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

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

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