Primary prophylaxis of variceal bleeding

Robertson, Marcus; Hayes, Peter

doi:10.1007/s12072-018-9846-1

Cited by 10 publications

(13 citation statements)

References 21 publications

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“…If medium and large varices are present, the need for prophylactic treatment is not in doubt because of the high probability of bleeding. In this case, the method of choice is either NSBB therapy or endoscopic band ligation 87 …”

Section: Primary Prevention Of Variceal Hemorrhagementioning

confidence: 99%

Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature

Garbuzenko

Arefyev

2020

J Evidence Based Medicine

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All patients with liver cirrhosis and portal hypertension should be stratified by risk groups to individualize different therapeutic strategies to increase the effectiveness of treatment. In this regard, the development of primary prophylaxis of variceal bleeding and its management according to the severity of portal hypertension may be promising. This paper is to describe the modern principles of primary prophylaxis of esophageal variceal bleeding in patients with liver cirrhosis. The PubMed and EMbase databases, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews were used to search for relevant publications from 1999 to 2019. The results suggested that depending on the severity of portal hypertension, patients with cirrhosis should be divided into those who need preprimary prophylaxis, which aims to prevent the formation of esophageal varices, and those who require measures that aim to prevent esophageal variceal bleeding. In subclinical portal hypertension, therapy should be etiological and pathogenetic. Cirrhosis with clinically significant portal hypertension should receive nonselective β‐blockers if they have small esophageal varices and risk factors for variceal bleeding. Nonselective β‐blockers are the first‐line drugs for the primary prevention of bleeding from medium to large‐sized esophageal varices. Endoscopic band ligation is indicated for the patients who are intolerant to nonselective β‐blockers or in the case of contraindications to pharmacological therapy. In summary, the stratification of cirrhotic patients by the severity of portal hypertension and an individual approach to the choice of treatment may increase the effectiveness of therapy as well as improve survival rate of these patients.

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Section: Primary Prevention Of Variceal Hemorrhagementioning

confidence: 99%

Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature

Garbuzenko

Arefyev

2020

J Evidence Based Medicine

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“…Several studies have demonstrated the similar effectiveness of NSBB use and esophageal variceal ligation (EVL) in variceal primary prophylaxis of variceal hemorrhage [13,14] . Besides that, the advantageous use of beta-blockers due to the lower occurrence of other complications associated with portal hypertension, mainly ascites [15] , is associated with the reduction of bacterial translocation and subsequent spontaneous bacterial peritonitis, making it an interestingly choice for primary prophylaxis.…”

Section: Journal Ofmentioning

confidence: 99%

“…Besides that, the advantageous use of beta-blockers due to the lower occurrence of other complications associated with portal hypertension, mainly ascites [15] , is associated with the reduction of bacterial translocation and subsequent spontaneous bacterial peritonitis, making it an interestingly choice for primary prophylaxis. Conversely, in the secondary prophylaxis of variceal bleeding, several studies reported that the association of EVL with pharmacological treatment, either propranolol or carvedilol, also improve the response to eradicating varices and reducing the rate of rebleeding [13] . Nevertheless, no statistical difference in the rate of side effects, bleeding-related mortality, or overall mortality was observed.…”

Section: Journal Ofmentioning

confidence: 99%

Beta-blockers and Statins: Role in Portal Hypertension and Beyond

Pace¹,

Val閞io²,

Oliveira³

et al. 2020

Journal of Gastroenterology and Hepatology Research

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Clinically significant portal hypertension is a cornerstone in cirrhosis's natural history, significantly impacting these patients' morbidity and mortality. Unless adequate preventive measures are implemented, the recurrence rate of bleeding can reach up to 65% of patients and with mortality of 57%. The goals in portal hypertension treatment focus on reducing the hepatic venous portal gradient, both by reducing portal blood flow and intrahepatic resistance. Nonselective beta-blockers and esophageal varices ligation have been the standard of care in esophageal varices' treatment. Currently, statins and carvedilol role in reducing portal pressure, preventing esophageal variceal bleeding, and other advanced liver disease complications seem to be promising.

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“…The main factors leading to the development of varices are continued hepatic injury, degree of portosystemic shunting, endoscopic appearances and portal pressure (5). Among these, the presence of large varices has demonstrated a major risk factor for the emergence of variceal hemorrhage (6,7). In patients with approximate portal hypertension, the likelihood of acute variceal bleeding is significantly increased in patients with large varices (6).…”

Section: Introductionmentioning

confidence: 99%

“…Among these, the presence of large varices has demonstrated a major risk factor for the emergence of variceal hemorrhage (6,7). In patients with approximate portal hypertension, the likelihood of acute variceal bleeding is significantly increased in patients with large varices (6).…”

Section: Introductionmentioning

confidence: 99%

Fibrosis index predicts variceal bleeding and reduces need for nonselective beta-blocker in compensated cirrhosis with initial small esophageal varices without red-color sign

Wang

Huang

et al. 2020

Ann Transl Med

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Background: Various non-invasive markers predicting hepatic fibrosis are poor predictors of esophageal variceal bleeding (EVB). Elastography performs well but resource-limited. Controversy for small EV prevention also exists. We aim to investigate if a non-invasive marker could predict subsequent EVB within 1 and 2 years in patients with compensated liver cirrhosis (CLC), initial small EV without red-color sign (RCS), without use of non-selective beta-blockers (NSBB) and endoscopic variceal ligation (EVL). This marker would also be tested if it could help reduce use of NSBB, thereby avoiding potential side effects and saving medical costs. Methods:In this retrospective cohort study, 6,803 CLC patients fulfilling the inclusion-exclusion criteria were enrolled between 2001 and 2018, and were followed-up for 1 year, 2 years. The primary outcomes were subsequent EVB within 1 and 2 years of enrollment. Another 281 CLC patients with NSBB use were compared for additional outcome analysis.Results: In total, 539 patients and 710 patients experienced EVB within 1 year and 2 years, respectively.The fibrosis index (FI) with cut-off value of 3.95 showed a negative predictive value (NPV) of 94.3% and an area under receiver operating characteristic (AUROC) of 62.95% for predicting subsequent EVB within 1 year. The EVB and mortality of patients with FI <3.95 and not taking NSBB were significantly lower than those of the other 3 groups. Similar results were demonstrated within 2 years. Conclusions:In CLC patients with initial small EV and no RCS, low FI scores showed a high NPV and moderate AUROC in predicting subsequent EVB and mortalities, signifying clinically non-significant portal hypertension. Patients with low FI scores and not taking NSBB had significantly lowest EVB and mortality.

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Primary prophylaxis of variceal bleeding

Cited by 10 publications

References 21 publications

Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature

Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature

Beta-blockers and Statins: Role in Portal Hypertension and Beyond

Fibrosis index predicts variceal bleeding and reduces need for nonselective beta-blocker in compensated cirrhosis with initial small esophageal varices without red-color sign

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