Session 7 - Prevention of Recurrent Variceal Haemorrhage (Secondary Prophylaxis)

2008 ◽  
pp. 170-179
Author(s):  
Didier Lebrec ◽  
Gregory V. Stiegmann
Keyword(s):  
Secondary Prophylaxis ◽  
Variceal Haemorrhage

Regional Survey on the Management of Oesophageal Variceal Haemorrhage

1995 ◽  
Vol 40 (5) ◽  
pp. 149-150 ◽  
Author(s):  
A.J. Stanley ◽  
J.F. Dillon ◽  
P.C. Hayes
Keyword(s):  
Beta Blockers ◽  
Secondary Prophylaxis ◽  
Shunt Surgery ◽  
Variceal Haemorrhage ◽  
Regional Survey ◽  
Band Ligation ◽  
North East ◽  
Portosystemic Shunts

A questionnaire was sent to 116 consultant gastroenterologists in Scotland and North-East England to assess their management of oesophageal variceal haemorrhage. Most respondents (58%) dealt with <10 variceal bleeds per year. Sclerotherapy, tamponade, vasoconstrictor therapy and oesophageal transection were available to 87.5–97.5% clinicians, compared with trans-jugular intrahepatic portosystemic shunts (T1PSS) (39.5%) and band ligation (27%). To arrest bleeding, sclerotherapy, tamponade, octreotide/somatostatin and vasopressin/ glypressin were used by 75.5%, 44.5%, 37% and 32% respectively (many used >1 treatment) and if bleeding continued, transection, TIPSS and shunt surgery were considered by 44.5%, 27% and 6%. Sclerotherapy was used for primary and secondary prophylaxis by 11% and 75.5%, and beta-blockers by 17.5% and 49.5% respectively. A wide variation in the management of variceal haemorrhage therefore exists. Most clinicians do not attempt to prevent primary variceal bleeds, with only a minority using beta-blockers but a significant number using sclerotherapy in this situation.

Diagnosis and management of variceal bleeding in the critically ill

2016 ◽  
Author(s):  
Deanna Blisard ◽  
Ali Al-Khafaji
Keyword(s):  
Venous Pressure ◽  
Portal Pressure ◽  
Primary Prophylaxis ◽  
Secondary Prophylaxis ◽  
Pharmacological Therapy ◽  
Variceal Haemorrhage ◽  
Gastroesophageal Varices ◽  
Endoscopic Intervention ◽  
Definitive Therapy ◽  
Haemorrhage Control

Cirrhosis is the most common cause of portal hypertension, which subsequently leads to development of gastroesophageal varices (GEV). Generally, presence of GEV correlates with the severity of cirrhosis and variceal haemorrhage can develop when hepatic venous pressure gradient exceeds 10–12 mmHg. The gold standard for diagnosis and often treatment of GEV is oesophagogastroduodenoscopy (OGD). Management of GEV is divided into primary prophylaxis, acute haemorrhage control, and secondary prophylaxis. Primary prophylaxis includes surveillance OGD and endoscopic intervention based on the size of the varices. Management of acute variceal haemorrhage includes resuscitation and endoscopic interventions. Basic resuscitative measures to maintain haemodynamic stability, vasoconstricting agents to decrease portal pressure, and the use of prophylactic antibiotics. Endoscopic intervention includes any of variceal band ligation, variceal sclerotherapy, and variceal obturation. Radiological or surgical portosystemic shunting markedly reduces portal pressure and are clinically effective therapy for patients who fail endoscopic or pharmacological therapy. Balloon tamponade is effective in temporarily controlling oesophageal variceal haemorrhage in over 80% of patients. Its use should be restricted to patients with uncontrollable bleeding, where more definitive therapy is planned within 24 hours. Secondary prophylaxis includes endoscopy plus pharmacological therapy of non-selective β‎−blockers.

Non-selective beta-blocker treatment does not impact on kidney function in patients on primary and secondary prophylaxis of variceal bleeding

2016 ◽  
Vol 54 (05) ◽  
Author(s):  
B Scheiner ◽  
D Parada-Rodriguez ◽  
T Bucsics ◽  
P Schwabl ◽  
M Mandorfer ◽  
...  
Keyword(s):  
Kidney Function ◽  
Beta Blocker ◽  
Variceal Bleeding ◽  
Secondary Prophylaxis

The beneficial effects of non-selective betabockers in secondary prophylaxis are most pronounced in patients without refractory ascites

2018 ◽  
Author(s):  
N Pfisterer ◽  
E Fuchs ◽  
M Mandorfer ◽  
T Pachofszky ◽  
M Bischof ◽  
...  
Keyword(s):  
Secondary Prophylaxis ◽  
Refractory Ascites ◽  
Beneficial Effects

PORTAL HYPERTENSIVE GASTROPATHY: A COMPREHENSIVE REVIEW

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Shabir Shiekh ◽  
Showkat Kadla ◽  
Bilal Khan ◽  
Nisar Shah
Keyword(s):  
Gastrointestinal Bleeding ◽  
Beta Blockers ◽  
Secondary Prophylaxis ◽  
Deficiency Anemia ◽  
Portal Hypertensive Gastropathy ◽  
Shunt Surgery ◽  
Comprehensive Review ◽  
Mucosal Changes ◽  
Gi Bleed ◽  
Gastric Mucosal Changes

Portal hypertensive gastropathy (PHG) encompasses the gastric mucosal changes occurring in the setting of portal hypertension,both cirrhotic and non-cirrhotic. Its significance lies in causing acute gastrointestinal bleeding and insidious chronic blood loss presenting as iron deficiency anemia. Diagnosis of PHG is straight-forward, made endoscopically often characterized by  a mosaic-like pattern resembling ‘snake-skin’, with or without red spots. Treatment of acute GI bleed is hemodynamic stabilization, vasoconstrictor therapy, antibiotic prophylaxis, non-selective beta-blockers. Endoscopic treatment like APC has a small role. In severe cases, TIPS and shunt surgery can be offered. Secondary prophylaxis of PHG bleeding with non-selective b-blockers is recommended. Keywords: Portal hypertension­, Gastrointestinal bleeding, Cirrhosis, Beta-blockers

Prevention of Preterm Birth

2018 ◽  
Vol 11 (2) ◽  
pp. 95-104
Author(s):  
Ivan D. Ivanov ◽  
Stefan A. Buzalov ◽  
Nadezhda H. Hinkova
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
High Risk ◽  
Medical Science ◽  
Secondary Prophylaxis ◽  
High Risk Group ◽  
Screening Methods ◽  
Perinatal Complications ◽  
Social Significance ◽  
Neonatal Deaths

Summary Preterm birth (PTB) is a worldwide problem with great social significance because it is a leading cause of perinatal complications and perinatal mortality. PTB is responsible for more than a half of neonatal deaths. The rate of preterm delivery varies between 5-18% worldwide and has not decreased in recent years, regardless of the development of medical science. One of the leading causes for that is the failure to identify the high-risk group in prenatal care. PTB is a heterogeneous syndrome in which many different factors interfere at different levels of the pathogenesis of the initiation of delivery, finally resulting in delivery before 37 weeks of gestation (wg). The various specificities of risk factors and the unclear mechanism of initiation of labour make it difficult to elaborate standard, unified and effective screening to diagnose pregnant women at high-risk for PTB correctly. Furthermore, they make primary and secondary prophylaxis less effective and render diagnostic and therapeutic measures ineffective and inappropriate. Reliable and accessible screening methods are necessary for antenatal care, and risk factors for PTB should be studied and clarified in search of useful tools to solve issues of risk pregnancies to decrease PTB rates and associated complications.

P28 Cessation of secondary prophylaxis in patients with cryptococcosis

HIV Medicine ◽  
2000 ◽  
Vol 1 (3) ◽  
pp. 181-181
Author(s):  
N Nwokolo ◽  
N Theobald ◽  
M Fisher ◽  
M Nelson
Keyword(s):  
Secondary Prophylaxis

Prophylaxis in people with haemophilia

2009 ◽  
Vol 101 (04) ◽  
pp. 674-681 ◽  
Author(s):  
Massimo Franchini ◽  
Annarita Tagliaferri ◽  
Antonio Coppola
Keyword(s):  
Quality Of Life ◽  
Cost Benefit ◽  
Primary Prophylaxis ◽  
Secondary Prophylaxis ◽  
Severe Haemophilia ◽  
Duration Of Treatment ◽  
First Choice ◽  
Long Term Treatment

SummaryA four-decade clinical experience and recent evidence from randomised controlled studies definitively recognised primary prophylaxis, i.e. the regular infusion of factor concentrates started after the first haemarthrosis and/or before the age of two years, as the first-choice treatment in children with severe haemophilia. The available data clearly show that preventing bleeding since an early age enables to avoid or reduce the clinical impact of muscle-skeletal impairment from haemophilic arthropathy and the related consequences in psycho-social development and quality of life of these patients. In this respect, the aim of secondary prophylaxis, defined as regular long-term treatment started after the age of two years or after two or more joint bleeds, is to avoid (or delay) the progression of arthropathy. The clinical benefits of secondary prophylaxis have been less extensively studied, especially in adolescents and adults; also in the latter better outcomes and quality of life for earlier treatment have been reported. This review summarises evidence from literature and current clinical strategies for prophylactic treatment in patients with severe haemophilia, also focusing on challenges and open issues (optimal regimen and implementation, duration of treatment, long-term adherence and outcomes, cost-benefit ratios) in this setting.

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