For people with esophageal varices due to liver cirrhosis, how do interventions for primary prevention of variceal bleeding compare with no active intervention and with one another?

2021 ◽  
Author(s):  
Jane Burch ◽  
Sarah El-Nakeep
Keyword(s):  
Liver Cirrhosis ◽  
Primary Prevention ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Active Intervention

Principles of primary prophylaxis of bleeding from oesophagealvaricies in patients with liver cirrhosis

2016 ◽  
Vol 94 (7) ◽  
pp. 503-509
Author(s):  
Dmitry V. Garbuzenko
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Primary Prevention ◽  
Esophageal Varices ◽  
Retrieval System ◽  
Primary Prophylaxis ◽  
Inclusion Criteria ◽  
Cochrane Reviews ◽  
Pubmed Database ◽  
Endoscopic Ligation

The principles of primary prevention of bleeding from esophageal varices in patients with liver cirrhosis are discussed with reference to the stage ofportal hypertension. The information was collectedfrom the PubMed database, Google Scholar retrieval system, Cochrane reviews, and lists of references from relevant publications for 1980-2015 using the key words «bleeding from esophageal varices», «prophylaxis», «portal hypertension». Inclusion criteria were confined to primary prophylaxis of bleeding from esophageal varices in patients with liver cirrhosis. The analysis showed that the drugs of choice for primary prophylaxis of bleeding from esophageal varices in patients with liver cirrhosis are non-selective beta-adrenoblockers, but their application is indicated only in case of clinicallyl significant portal hypertension in patients with large and mediumsize esophageal varices. When the use of these drugs is contraindicated, endoscopic ligation of esophageal varices can be recommended.

Primary prevention of variceal bleeding in people with oesophageal varices due to liver cirrhosis: a network meta-analysis

2021 ◽  
Author(s):  
Davide Roccarina ◽  
Lawrence MJ Best ◽  
Suzanne C Freeman ◽  
Danielle Roberts ◽  
Nicola J Cooper ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Primary Prevention ◽  
Variceal Bleeding ◽  
Meta Analysis ◽  
Oesophageal Varices

scholarly journals A study on non endoscopic predictors of esophageal varices and portal hypertension in chronic liver disease

2020 ◽  
Vol 11 (SPL2) ◽  
pp. 228-234
Author(s):  
Karthick M ◽  
Prabakaran P T ◽  
Rajendran K ◽  
Gowrishankar A ◽  
Halleys Kumar E ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Chronic Liver ◽  
First Episode ◽  
Oesophageal Varices ◽  
Screening Endoscopy

Portal hypertension is associated with liver cirrhosis and esophageal varices is a common complication. Cirrhotic liver increases resistance to the passage of blood and thereby increased splanchnic blood flow secondary to vasodilation. Prevalence of portal hypertension varies from 50-60% in patients with liver cirrhosis. The first episode of variceal bleeding causes mortality, which ranges from 40-70%. All cirrhotic patients should be screened for the oesophageal varices according to  Baveno III consensus conference on portal hypertension and recommendation for endoscopy is at 2-3 years intervals in patients without varices and at 1-2 years interval in patients with small varices in order to evaluate the development or variceal progression. But this is questionable as endoscopy is an invasive procedure and also cost-effective. Only 9-36% of patients with cirrhosis were found to have varices on screening endoscopy. Non-invasive assessment of variceal bleeding with good predictivity includes biochemical, clinical and ultrasonographic parameters. Thus unnecessary intervention is avoided and at the same time, the patients at risk of bleeding are also not missed. This study emphasizes the need for an annual ultrasonogram examination as a part of a surveillance program for screening of oesophageal varices in patients of chronic liver disease.

scholarly journals Primary prevention of bleeding esophageal varices in patients with liver cirrhosis

2020 ◽  
pp. 56-61
Author(s):  
N. N. Smagina
Keyword(s):  
Liver Cirrhosis ◽  
Primary Prevention ◽  
Esophageal Varices ◽  
Beta Blockers ◽  
Control Group ◽  
Endoscopic Screening ◽  
Basic Group ◽  
Drug Of Choice ◽  
Bleeding Esophageal Varices ◽  
Observation Period

Objective: to evaluate the effectiveness of the application of beta-blockers for primary prevention of bleeding esophageal varices in patients with liver cirrhosis. Material and methods. A retrospective study included 46 patients with liver cirrhosis of various etiology having II-III stage esophageal varices. All the patients were divided into two equal groups. The basic group was made up of 23 (50 %) patients who were prescribed beta-blockers at recommended dosages continuously over the observation period from 2009 till 2018 for the purpose of primary prevention of bleeding esophageal varices. The control group included 23 (50 %) patients with liver cirrhosis in whom the primary prevention of the bleedings was not performed. Results. The assessment of the effectiveness of beta-blockers was performed with two indicators: the frequency of bleeding esophageal varices and their mortality. The application of beta-blockers made it possible to reduce the bleeding frequency from 34.8 % to 13 % (р = 0.10) and the mortality from 21.7 % to 0 % (р = 0.02). Conclusion. In order to detect early stages of esophageal varices, endoscopic screening should be performed for all patients with liver cirrhosis. The presence of II-III stage esophageal varices requires primary prevention of the bleedings. The drug-of-choice are non-selective beta-blockers. Timely and adequately prevention reduces the risk of the bleedings and their mortality.

scholarly journals Prediction of Aspartate Aminotransferase to Platelet Ratio Index with Size of Esophageal Varices in Liver Cirrhosis

2019 ◽  
Vol 17 (01) ◽  
pp. 38-41
Author(s):  
Amrendra K Mandal ◽  
Prashant Subedi ◽  
Mukesh Sharma Paudel ◽  
Suman Thapa ◽  
Paritosh Kafle ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Predictive Value ◽  
Aspartate Aminotransferase ◽  
Count Ratio ◽  
Institutional Review ◽  
Ethical Approval ◽  
Small Varices

Background: Liver cirrhosis is one of the major causes of morbidity and mortality. The threatening complication of Liver cirrhosis is variceal bleeding. Early diagnosis and initiation of therapy can reduce mortality associated with variceal bleeding. This study is designed to predict the esophageal varices by non-invasive method using aspartate aminotransferase to platelet count ratio index (APRI).Methods: A total of 100 patients were studied between March 2016 and February 2017 with the diagnosis of Liver cirrhosis admitted at Bir Hospital fulfilling the inclusion and exclusion criteria. Ethical approval was obtained from Institutional review board of National Academy of Medical Sciences.Results: Out of one hundred patients, 80 were males and 20 females. On endoscopy, small varices were present in 28 (28%) patients and large varices in 51(51%) patients. APRI with a cutoff value of 0.908 has sensitivity of 87.3% and specificity of 71.4%, positive predictive value of 92% and negative predictive value of 60% (p=0.001) for the detection of varices.Conclusions: Aspartate aminotransferase to platelet count ratio index can be a useful tool to indirectly predict esophageal varices in a patient with Liver Cirrhosis.Keywords: Aminotransferase; aminotransferase to platelet ratio index APRI; esophageal varices; liver cirrhosis; platelet count.

Endoscopic varices legation (E.V.L.) for the primary prevention of the variceal bleeding in PTS with high risk esophageal varices

2000 ◽  
Vol 32 ◽  
pp. A72
Author(s):  
P. Billi ◽  
P. Andreone ◽  
D. Barboncini ◽  
M. Biselli ◽  
A. Casadei ◽  
...  
Keyword(s):  
Primary Prevention ◽  
High Risk ◽  
Esophageal Varices ◽  
Variceal Bleeding

scholarly journals Predictors of esophageal varices and first variceal bleeding in liver cirrhosis patients

2017 ◽  
Vol 23 (26) ◽  
pp. 4806 ◽  
Author(s):  
Bledar Kraja ◽  
Iris Mone ◽  
Ilir Akshija ◽  
Adea Koçollari ◽  
Skerdi Prifti ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Esophageal Varices ◽  
Variceal Bleeding

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

2020 ◽  
Vol 13 (4) ◽  
pp. 313-324
Author(s):  
Dmitry Victorovich Garbuzenko ◽  
Nikolay Olegovich Arefyev
Keyword(s):  
Liver Cirrhosis ◽  
Primary Prevention ◽  
Esophageal Varices ◽  
Review Of The Literature

scholarly journals Risk and causes of gastroesophageal bleeding in patients with liver cirrhosis

2007 ◽  
Vol 64 (9) ◽  
pp. 585-589 ◽  
Author(s):  
Daniela Benedeto-Stojanov ◽  
Aleksandar Nagorni ◽  
Bojan Mladenovic ◽  
Dragan Stojanov ◽  
Nebojsa Djenic
Keyword(s):  
Liver Cirrhosis ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Hepatic Dysfunction ◽  
First Episode ◽  
Coagulation Parameters ◽  
Endoscopic Findings ◽  
Initial Episode ◽  
Group B ◽  
Small Varices

Background/Aim. Variceal bleeding is the most life-threating complication in liver cirrhosis. The aim of this study was to analyze the sources of gastroesophageal bleeding in patients with liver cirrhosis and to ascertain the risk factors of bleeding from esophageal varices. Methods. This prospective study included 52 patients with liver cirrhosis and portal hypertension. Severity of liver dysfunction according to Child?s classification, coagulation parameters, and endoscopic findings were analyzed. In patients with varices we analyzed the size, color, location of varices, and the presence of red signs. The varices were classified as small, medium and large. Results. Esophageal varices were found in 76.9% of the patients. Isolated varices were present in 36.6%, and associated with other findings in 40,3%. Small varices were present in 10%, medium in 25% and large in 65% patients. Of them 55% had variceal bleeding. Variceal bleeding was present in 50% of the patients with medium and in 65.38% of the patients with large varices. There was no bleeding in the patients with small varices. Endoscopy revealed red signs before bleeding in 85% of the patients with large varices. There was a higher incidence of variceal bleeding in the Child?s group B. There were no significant differences (p > 0.05) in the coagulation parameters in patients with and without variceal bleeding. Rebleeding was present in 86.36% of the patients. Most of them (52.63%) were rebleeding between 7 weeks and 12 months after the first episode of variceal bleeding. In the patients with the most severe hepatocellular dysfunction (Child?s group C) the period between the first bleeding and rebleeding was the shortest (mean, 20.8 days). Conclusion. Our study revealed that esophageal varices are the most frequent sources of bleeding in the patients with liver cirrhosis. There is the association between the first bleeding and large varices and the red signs. Coagulation disorders and hepatic dysfunction were not related to the initial episode of variceal bleeding. The risk of early rebleeding was higher in the patients with severe hepatic dysfunction (Child?s class C). .

scholarly journals Hepatic venous pressure gradient measurement in patients with liver cirrhosis: A correlation with disease severity and variceal bleeding

Medicina ◽  
2009 ◽  
Vol 45 (1) ◽  
pp. 8 ◽  
Author(s):  
Vilma Šilkauskaitė ◽  
Andrius Pranculis ◽  
Dalia Mitraitė ◽  
Laimas Jonaitis ◽  
Vitalija Petrenkienė ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Pressure Gradient ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Venous Pressure ◽  
Hepatic Venous Pressure Gradient ◽  
Grade Ii ◽  
The Mean ◽  
Gradient Measurement

The aim of present study was to evaluate relationships between degree of portal hypertension, severity of the disease, and bleeding status in patients with liver cirrhosis. Patients and methods. All study patients with liver cirrhosis underwent hepatic venous pressure gradient measurements, endoscopy, clinical and biochemical evaluation. Liver function was evaluated according to Child-Turcotte-Pugh (Child’s) scoring system. Patients with decompensated cirrhosis (presence of severe ascites, acute variceal bleeding occurring within 14 days, hepatorenal syndrome, cardiopulmonary disorders, transaminase levels >10 times higher the upper normal limit), active alcohol intake, use of antiviral therapy and/or beta-blockers were excluded from the study. Results. One hundred twenty-eight patients with liver cirrhosis (male/female, 67/61; mean age, 53.8±12.7 years) were included into the study. Etiology of cirrhosis was viral hepatitis, alcoholic liver disease, cryptogenic and miscellaneous reasons in 57, 49, 14, and 8 patients, respectively. Child’s stages A, B, and C of liver cirrhosis were established in 28 (21.9%), 70 (54.9%), and 30 (23.4%) patients, respectively. The mean hepatic venous pressure gradient significantly differed among patients with different Child’s classes: 13.8±5.3 mm Hg, 17.3±4.6 mm Hg, and 17.7±5.05 mm Hg in Child’s A, B, and C classes, respectively (P=0.003). The mean hepatic venous pressure gradient in patients with grade I, II, and III varices was 14.8±4.5, 16.1±4.3, and 19.3±4.7 mm Hg, respectively (P=0.0001). Since nonbleeders had both small and large esophageal varices, patients with large varices were analyzed separately. The mean hepatic venous pressure gradient in patients with large (grade II and III) varices was significantly higher than that in patients with small (grade I) varices (17.8±4.8 mm Hg vs 14.6±4.8 mm Hg, P=0.007). Thirty-four (26.6%) patients had a history of previous variceal bleeding; all of them had large (20.6% – grade II, and 79.4% – grade III) varices. In patients with large varices, the mean hepatic venous pressure gradient was significantly higher in bleeders than in nonbleeders (18.7±4.7 mm Hg vs 15.9±4.7 mm Hg, P=0.006). Conclusions. Hepatic venous pressure gradient correlates with severity of liver disease, size of varices, and bleeding status. Among cirrhotics with large esophageal varices, bleeders have a significantly higher hepatic venous pressure gradient than nonbleeders. Hepatic venous pressure gradient measurement is useful in clinical practice selecting cirrhotic patients at the highest risk of variceal bleeding and guiding to specific therapy.

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