Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

García–Tsao, Guadalupe; Sanyal, Arun J.; Grace, Norman D.; Carey, William D.; Shuhart, Margaret C.; Davis, Gary L.; Bambha, Kiran; Cárdenas, Andrés; Cohen, Stanley M.; Davern, Timothy J.; Flamm, Steven L.; Han, Steven; Howell, Charles D.; Nelson, David R.; Reddy, K. Rajender; Runyon, Bruce A.; Wong, John B.; Yim, Colina; Inadomi, John M.; Baroni, Darren; Bernstein, David; Brugge, William R.; Chang, Lin; Chey, William D.; Cunningham, John; DeVault, Kenneth R.; Edmundowicz, Steven A.; Fass, Ronnie; Hornbuckle, Kenneth; Kefalas, Costas; Koch, Timothy R.; Lehrer, Jenifer K.; Lembo, Anthony; O’Brien, John; Papp, John P.; Parkman, Henry P.; Roach, Albert C.; Sampliner, Richard E.; Sonnenberg, Amnon; Sridhar, Subbaramiah; Valdovinos, Miguel A.; Vargo, John J.; Vela, Marcelo F.; Zein, Nizar N.

doi:10.1002/hep.21907

Cited by 1,552 publications

(954 citation statements)

References 139 publications

(182 reference statements)

Supporting

Mentioning

871

Contrasting

Unclassified

Order By: Relevance

“…Terlipressin is a synthetic vasopressin analogue that produces systemic vasoconstriction through its V 1 receptor agonist activity 11. In several small, randomised, controlled studies, terlipressin treatment was shown to improve renal function in patients with HRS‐1 by significantly reducing SCr 12, 13, 14, 15, 16. Meta‐analyses of these studies of terlipressin in HRS‐1 support the beneficial effect of terlipressin on renal function 17, 18…”

Section: Introductionmentioning

confidence: 95%

Reversal of hepatorenal syndrome type 1 with terlipressin plus albumin vs. placebo plus albumin in a pooled analysis of the OT‐0401 and REVERSE randomised clinical studies

Sanyal

Boyer

Frederick

et al. 2017

Aliment Pharmacol Ther

View full text Add to dashboard Cite

SummaryBackgroundThe goal of hepatorenal syndrome type 1 (HRS‐1) treatment is to improve renal function. Terlipressin, a synthetic vasopressin analogue, is a systemic vasoconstrictor used for the treatment of HRS‐1, where it is available.AimTo compare the efficacy of terlipressin plus albumin vs. placebo plus albumin in patients with HRS‐1.MethodsPooled patient‐level data from two large phase 3, randomised, placebo‐controlled studies were analysed for HRS reversal [serum creatinine (SCr) value ≤133 μmol/L], 90‐day survival, need for renal replacement therapy and predictors of HRS reversal. Patients received intravenous terlipressin 1–2 mg every 6 hours plus albumin or placebo plus albumin up to 14 days.ResultsThe pooled analysis comprised 308 patients (terlipressin: n = 153; placebo: n = 155). HRS reversal was significantly more frequent with terlipressin vs. placebo (27% vs. 14%; P = 0.004). Terlipressin was associated with a more significant improvement in renal function from baseline until end of treatment, with a mean between‐group difference in SCr concentration of −53.0 μmol/L (P < 0.0001). Lower SCr, lower mean arterial pressure and lower total bilirubin and absence of known precipitating factors for HRS were independent predictors of HRS reversal and longer survival in terlipressin‐treated patients.ConclusionsTerlipressin plus albumin resulted in a significantly higher rate of HRS reversal vs. albumin alone in patients with HRS‐1. Terlipressin treatment is associated with improved renal function. (ClinicalTrials.gov identifier: OT‐0401, NCT00089570; REVERSE, NCT01143246).

show abstract

Section: Introductionmentioning

confidence: 95%

Reversal of hepatorenal syndrome type 1 with terlipressin plus albumin vs. placebo plus albumin in a pooled analysis of the OT‐0401 and REVERSE randomised clinical studies

Sanyal

Boyer

Frederick

et al. 2017

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

“…Upper gastrointestinal endoscopy (UGIE) should be performed once the diagnosis of cirrhosis is established and is the gold standard for the diagnosis of varices [2,[5][6][7]. For definitions relative to prophylactic treatment of gastroesophageal varices, primary prophylaxis relates to offering treatment to prevent the first variceal bleed in patients who have never had any previous variceal hemorrhage [5].…”

Section: Definitions Of Varices and Variceal Bleed Prophylaxismentioning

confidence: 99%

“…Its role for screening varices needs further studies. UGIE should be part of the routine clinical practice once the diagnosis of cirrhosis is made [1,2,[5][6][7]. Studies have reported that UGIE is reliable and has shown good agreement between observers for the size of varices and the presence of red signs [17,18].…”

Section: Definitions Of Varices and Variceal Bleed Prophylaxismentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2008

View full text Add to dashboard Cite

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.

show abstract

“…Due to the high incidence of viral hepatitis, as well as the steady growth of factors such as alcohol, drugs or toxic liver injury, its social importance is steadily increasing in many countries. [1][2][3] Although the average age of patients with LC in Europe and the USA is 55±10 years, in Central Asian region tendency to "rejuvenation" of the disease, up to 25 years old and younger. 1 Often determined by the fatal prognosis, the two main complications of LC are: bleed-ing of esophageal and gastric varices (EGV) and progression of liver failure with encephalopathy.…”

Section: Introductionmentioning

confidence: 99%

Comparisons between Portosystemic Shunting Modalities in Patients with Liver Cirrhosis and Portal Hypertension

Nazyrov¹,

Benítez²,

Devyatov³

et al. 2017

Liver Res Open J

View full text Add to dashboard Cite

show abstract

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

Cited by 1,552 publications

References 139 publications

Reversal of hepatorenal syndrome type 1 with terlipressin plus albumin vs. placebo plus albumin in a pooled analysis of the OT‐0401 and REVERSE randomised clinical studies

Reversal of hepatorenal syndrome type 1 with terlipressin plus albumin vs. placebo plus albumin in a pooled analysis of the OT‐0401 and REVERSE randomised clinical studies

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

Comparisons between Portosystemic Shunting Modalities in Patients with Liver Cirrhosis and Portal Hypertension

Contact Info

Product

Resources

About