Navigation Links
Preventing variceal bleeding
Date:9/6/2007

Beta blockers should be the first line of prevention against variceal bleeding in patients with cirrhosis and portal hypertension. While banding is similarly effective in reducing the incidence of such bleeding, it can have fatal complications and is more expensive. These findings are published in the September issue of Liver Transplantation, a journal by John Wiley & Sons. The article is also available online via Wiley Interscience at http://www.interscience.wiley.com/journal/livertransplantion

Patients with liver disease often develop portal hypertension from a blockage in the blood flow through the liver. The increased blood pressure in the portal vein causes large veins, called varices, to develop across the esophagus and stomach to bypass the blockage. The se varices become fragile and can bleed easily, causing frightening symptoms like vomiting blood, as well as ascites and encephalopathy. Two ways to prevent variceal bleeding are beta blockers and endoscopic variceal ligation, however it is unclear which is better for patients.

To compare the safety and efficacy of the two therapies in the prevention of primary variceal bleeding, researchers led by Lorenzo Norberto and Lino Polese of the University of Padova in Italy, conducted a randomized controlled trial among patients awaiting liver transplantation. Between September 2001 and December 2005, they enrolled sixty-two patients with Child-B-C cirrhosis and high-risk esophagal varices into their study. The patients were randomly divided between treatment with the beta blocker, propranolol, or variceal banding. All patients had an EGD and a clinical examination every 6 months after beginning treatment.

The 31 patients who took beta blockers started on a low dose and increased it until they achieved a 25 percent reduction of their baseline heart rate. Five patients had to suspend the treatment due to complications including bradycardia, persistent hypotension and vertigo. Of the 26 who continued the treatment, three eventually bled from esophageal varices and two died of such bleeding. During the mean follow-up of 7.6 months, ten of the patients underwent liver transplantation.

Of the 31 patients treated with ligation, two suffered a dramatic hemorrhage a few days after the first treatment and required emergency treatment. One patient recovered, the other died. The remaining patients underwent three ligation sessions to completely eradicate their varices. During the mean follow up of almost 15 months, two patients died of liver failure after 1 and 7 months respectively, while 14 of the patients received a liver transplant.

Both propranolol and endoscopic banding considerably reduced the expected incidence of bleeding, normally 30 percent after one year. The beta blocker lowered the risk to less than 10 percent, the banding to less than 7 percent. Although some patients in each group experienced adverse events related to their treatment, only banding was associated with a death.

Beta blockers should remain the first choice of prophylactic therapy in candidates for liver transplantation, the authors report, though banding should be used when beta-blockers are contraindicated. Both propranolol and endoscopic banding are similarly effective in reducing the incidence of variceal bleeding in cirrhotic patients with high risk varices, but ligation can be complicated by severe and fatal bleeding and is significantly more expensive, they conclude. The mean cost for treatment with propranolol was $1425, compared to $4289 for banding.

In an accompanying editorial, Thomas Boyer of the Liver Research Institute at Arizona Health Sciences Center applauds the strides that have been made however, he says, there are still areas where further studies are warranted in the prevention and management of variceal bleeding. Not all patients treated with beta-blockers benefit from the treatment and remain at high risk for bleeding.

Identification of new drugs that lower portal pressure to the same or greater degree than beta-blockers with fewer side-effects are being sought and if found will further improve the management of the patient with varices, he says.


'/>"/>

Contact: Amy Molnar
amolnar@wiley.com
John Wiley & Sons, Inc.
Source:Eurekalert

Related medicine news :

1. Preventing Childhood Deaths
2. Yoga for preventing weight gain in middle age
3. Preventing mental decline in the aged
4. Preventing white coat hypertension
5. Green tea beneficial in preventing osteoarthritis
6. Preventing Vision Loss
7. Preventing Vision Loss
8. Preventing Colorectal Cancer
9. Preventing Prostate Cancer
10. Lycopene Can Help In Preventing Prostate Cancer
11. Heart Drug Also Effective In Preventing Specific Causes Of Death
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:8/19/2017)... ... August 19, 2017 , ... “Congratulations! It's A Boy! ... children to both their parents and God. “Congratulations! It's A Boy! God’s Gift: A ... a couple from Long Island, New York. , Published by Christian Faith Publishing, Dale ...
(Date:8/18/2017)... ... August 18, 2017 , ... ... specialized asset-light logistics provider of complex transport solutions for mission-critical and non-discretionary ... Unitrans International Corporation, a division of Roadrunner Transportation Systems, Inc. (NYSE: RRTS). ...
(Date:8/18/2017)... ... August 18, 2017 , ... ... handheld devices. Through an educational webinar, they will present the line of epMotion ... to learn how easy you can automate everyday pipetting tasks. , Ideal for ...
(Date:8/18/2017)... TX (PRWEB) , ... August 18, 2017 , ... ... assistance and financial planning services to communities in east Texas, is launching a ... Brain Tumor Foundation. , Founded in 1991, the Pediatric Brain Tumor Foundation (PBTF) ...
(Date:8/18/2017)... ... 2017 , ... The Golseth Agency, a Texas based insurance management and financial ... regional charity campaign organized to provide support to Christina Upchurch and her two children ... and her children returned from out of town to find her husband passed away ...
Breaking Medicine News(10 mins):
(Date:8/15/2017)... HIGH POINT, N.C. , Aug. 15, 2017  Axium Pharmaceuticals Inc., ... epilepsy is rumored to be in the beginning stages of an IPO. ... billion annually on epilepsy medications with the average cost of a prescription ... ... Another staggering figure is ...
(Date:8/11/2017)... Israel , Aug. 11, 2017 DarioHealth ... with mobile health and big data solutions, today announced ... on Monday, August 14 and host a conference call ... quarter 2017 operating and financial results and its strategy ... will be hosted by Erez Raphael , Chief ...
(Date:8/7/2017)... , Aug. 7, 2017 Insightin ... member acquisition, retention, and engagement, announced the selection ... Strategy and Product Development, effective as of February 2017. ... and technology implementation strategy for our clients. Wood ... experience in consulting and business analytics within the ...
Breaking Medicine Technology: