Navigation Links
Study finds beta blockers alone more effective for first variceal bleeding
Date:6/9/2010

A controlled trial conducted by researchers at the E-DA Hospital in Kaohsiung, Taiwan, suggests that a combination of band ligation and nadolol may not be the most effective prophylaxis for first variceal bleeding resulting from cirrhosis. Results of this study appear in the July issue of Hepatology, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases (AASLD).

Esophageal varices (EV) are abnormally enlarged veins in the esophagus that occur when portal hypertension obstructs normal blood flow to the liver and causes the blood to back up into the esophageal vessels. Variceal rupture is a life-threatening condition. Approximately one third of cirrhotic patients with esophageal varices bleed, and the mortality rate associated with first bleed may be as high as 50%.

The World Gastroenterology Organization practice guideline for esophageal varices in patients with cirrhosis and medium or large varices, but no hemorrhage, recommends nonselective beta blockers (propranolol or nadolol) or endoscopic variceal ligation (EVL) for prevention of first variceal hemorrhage for patients at highest risk, and propranolol or nadolol for those who are not high risk or in whom EVL is not tolerated.

Beta blockers are generally considered the treatment of choice for prophylaxis of first variceal bleeding. A noninvasive method, beta blockers are able to reduce portal pressure, thus reducing the risk of variceal bleeding. While some studies suggest that EVL is superior to beta blockers, it is also associated with serious complications. The Taiwan study was conducted to evaluate the effectiveness of both treatments administered in combination.

Study leader Gin-Ho Lo, M.D. explained the rational behind testing these treatment approaches together. "The strength of EVL lies in its ability to obliterate varices, but portal pressure may be elevated after repeated procedures. Moreover, varices frequently recur after variceal obliteration achieved by EVL and beta blockers were documented to be able to reduce variceal recurrence. A combination of nadolol and EVL has been well established in preventing secondary variceal bleeding, but the effectiveness of this approach is unknown in preventing the first variceal bleeding."

Cirrhotic patients with high-risk esophageal varices but without bleeding history were enrolled in the randomized study. Eligible patients were required to have portal hypertension resulting from cirrhosis; moderate varices associated with red color signs (red wale markings, cherry red spots); no history of hemorrhage from esophageal varices or other upper gastrointestinal lesion; and no current treatment with beta-blockers. Seventy patients received band ligation plus nadolol and seventy received nadolol alone.

Patients in the combined group received regular ligation treatment at an interval of 4 weeks until variceal obliteration. Nadolol was administered at a dose to reduce 25% of pulse rate in both groups. During a median follow-up of 26 months, 18 patients (26%) in the combined group and 13 patients (18%) in nadolol group experienced upper gastrointestinal bleeding. Esophageal variceal bleeding occurred in 10 patients (14%) in the combined group and 9 patients (13%) in nadolol group. Adverse events were noted in 48 patients (68%) in the combined group and 28 patients (40%) in nadolol group. Sixteen patients in each group died, mostly from hepatic failure or sepsis.

"Our findings indicated that the addition of ligation to nadolol may increase adverse events and does not enhance effectiveness in preventing first variceal bleeding, concluded Dr. Lo. "Previous meta analysis of trials found that severe adverse events were significantly less in EVL compared with beta blockers. Based on our observation, nadolol alone did not cause severe adverse events if nadolol was reduced or discontinued in patients who reported side effects. The value of EVL in combination therapy requires further investigation."


'/>"/>

Contact: Dawn Peters
healthnews@wiley.com
781-388-8408
Wiley-Blackwell
Source:Eurekalert

Related medicine news :

1. Casual Sex Doesnt Cause Emotional Damage: Study
2. Study Finds Possible Explanation for the Link Between Infertility and Breast/Ovarian Cancer Risks
3. Screening for Spinal Muscular Atrophy Not Cost-Effective: Study
4. New study finds possible source of beta cell destruction that leads to Type 1 diabetes
5. New Study Demonstrates Novel Use of Metabolic Imaging to Locate Sperm in Infertile Men -- Non-Invasive Imaging Procedure May Replace Invasive Techniques such as Testicula
6. Risk of stroke lower for recent Ontario immigrants: study
7. Definitive study confirms chemo benefit in postmenopausal breast cancer
8. Experimental stem cell treatment arrests acute lung injury in mice, study shows
9. Violence is part of the job say nurses as study shows only 1 in 6 incidents are reported
10. Controversial Autism Study Retracted by Medical Journal
11. Study Reveals Impact Of Health Insurance On Hispanics' Attitudes Towards Healthcare Providers
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/27/2016)... ... June 27, 2016 , ... TherapySites, the leading ... with Tennessee Counseling Association. This new relationship allows TherapySites to continue ... Association, adding exclusive benefits and promotional offers. , "TCA is extremely excited about ...
(Date:6/27/2016)... ... 2016 , ... TopConsumerReviews.com recently awarded their highest five-star rating to Best Buy ... in the United States and Canada wear eyeglasses. Once considered to be a purely ... make a fashion statement. Even celebrities use glasses as a way of creating an ...
(Date:6/26/2016)... ... , ... Pixel Film Studios Released ProSlice Levels, a Media Slicing Effect ... a whole new perspective by using the title layers in ProSlice Levels to ... ProSlice Levels contains over 30 Different presets to choose from. FCPX users ...
(Date:6/26/2016)... (PRWEB) , ... June 26, 2016 , ... ... fertility once they have been diagnosed with endometriosis. These women need a treatment ... also require a comprehensive approach that can help for preservation of fertility and ...
(Date:6/25/2016)... ... ... The temporary closing of Bruton Memorial Library on June 21 due to a possible lice ... overlooked aspect of head lice: the parasite’s ability to live away from a human host, ... a necessary one in the event that lice have simply gotten out of control. , ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... 2016   Pulmatrix, Inc ., (NASDAQ: ... drugs, announced today that it was added to the ... its comprehensive set of U.S. and global equity indexes ... important milestone for Pulmatrix," said Chief Executive Officer ... our progress in developing drugs for crucial unmet medical ...
(Date:6/23/2016)... , June 23, 2016 Any dentist who has ... of the current process. Many of them do not even ... technical difficulties and high laboratory costs involved. And those who ... it at such a high cost that the majority of ... Dr. Parsa Zadeh , founder of Dental Evolutions ...
(Date:6/23/2016)... , June 23, 2016 ... CAPR ), a biotechnology company focused on ... today announced that patient enrollment in its ongoing ... Duchenne) has exceeded 50% of its 24-patient target. ... in the third quarter of 2016, and to ...
Breaking Medicine Technology: