Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients

Chavez-Tapia, Norberto C; Soares‐Weiser, Karla; Brezis, Mayer; Leibovici, Leonard

doi:10.1002/14651858.cd002232.pub2

Cited by 30 publications

(16 citation statements)

References 40 publications

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“…However, patients with cardiopulmonary disease or severe other comorbidities may require a hemoglobin level of 9-10 g/dL [263] . Antibiotic prophylaxis is generally recommended for bleeding from PHG [214] , just as it is recommended for esophageal variceal bleeding in cirrhotic patients [189,[264][265][266] because of an increased risk of systemic infections, particularly spontaneous bacterial peritonitis, in cirrhotic patients with GI bleeding [267] . Bleeding from PHG may be exacerbated by a coagulopathy with an elevated international normalized ratio from advanced liver disease.…”

Section: Summary Of Clinical Treatmentmentioning

confidence: 99%

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Gjeorgjievski¹

2016

WJH

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AIM:To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy (PHG) based on a systematic literature review. METHODS:Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. RESULTS:PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG. Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibility to gastrotoxic chemicals and poor wound healing. Nitrous oxide, free radicals, tumor necrosis factor-alpha, and glucagon may contribute to PHG development. Acute and chronic gastrointestinal bleeding are the only clinical complications. Bleeding is typically mild-to-moderate. Endoscopic therapy is rarely useful because the bleeding is typically diffuse. Acute bleeding is primarily treated with octreotide, often with concomitant proton pump inhibitor therapy, or secondarily treated with vasopressin or terlipressin. Nonselective β-adrenergic receptor antagonists, particularly propranolol, are used to prevent bleeding after an acute episode or for chronic bleeding. Iron deficiency anemia from chronic bleeding may require iron replacement therapy. Transjugular-intrahepaticportosystemic-shunt and liver transplantation are highly successful ultimate therapies because they reduce the underlying portal hypertension. SYSTEMA...

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Section: Summary Of Clinical Treatmentmentioning

confidence: 99%

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Gjeorgjievski¹

2016

WJH

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“…Antibiotics are often used in patients with cirrhosis and are effective in preventing the recurrence of SBP and reducing infections and mortality in patients with upper GI bleeding. 104,105 Few studies have directly examined antibiotics and the gut microbiome using culture-independent techniques.…”

Section: Treatments Targeting Microbiota In Cirrhosismentioning

confidence: 99%

The Human Gut Microbiome in Liver Diseases

Davis

Bajaj

2017

Semin Liver Dis

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Recent advances in culture-independent laboratory techniques and bioinformatics have contributed to enriched characterizations of the gut microbiota and microbiome in chronic liver diseases such as alcoholic liver disease, nonalcoholic fatty liver disease, primary sclerosing cholangitis, primary biliary cholangitis, and cirrhosis. In this review, the authors focus on studies characterizing and modulating the gut microbiota and microbiome in humans. The majority of studies that characterized microbiota involved a small number of patients using 16S ribosomal RNA genetic sequencing. Few studies applied whole-genome shotgun sequencing and metagenomics analyses. The majority of clinical trials on modulating the microbiome have focused on probiotics or antibiotics in small groups of patients with cirrhosis versus healthy controls. Several trials are underway using fecal microbial transplantation in alcoholic liver disease, nonalcoholic fatty liver disease, primary sclerosing cholangitis, and cirrhosis. Future research is needed on understanding the viral and fungal microbiome and developing user-friendly microbiome tools.

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“…Die primäre Form der Peritonitis ist mit 1 % aller Formen selten und betrifft hauptsächlich Patienten mit Leber-und Nierenerkrankungen (spontane bakterielle Peritonitis, Peritonitis durch Peritonealdialyse), bei denen die Bauchhöhle hämatogen, lymphogen oder transluminal infiziert wird [16]. Die Therapie der primären Peritonitis ist in erster Linie antibiotisch und konzentriert sich auf die Grunderkrankung [17].…”

Section: Das Akute Abdomen Auf Der Intensivstationunclassified