The effect of bacterial infections in cirrhotic patients with esophageal variceal bleeding

Objectives: 1. To investigate the prevalence of portal hypertensive gastropathy (PHG) and the ratio of mild/severe PHG. 2. The impact of esophageal variceal ligation (EVL) combined propranolol on the progress of PHG in terms of prevalence, distribution and severity. Patients and methods: Prospective, controlled study. Cirrhotic patients with the history of esophageal variceal bleeding or acute esophageal variceal bleeding in stable condition were devided into combined group: EVL combined propranolol (study group) and propranolol only (control group). Results: Sex ratio Male/Female: 82/4 = 20.5. Majority of cirrhotic etiology was alcohol: 73.3%. Esophageal varices grade II and III, no grade I. Prevalence of PHG: 90.7%, ratio of mild/ severe PHG: 12.8%/87.2%. The ratio, distribution and severity of PHG between the study group and control group after 3 and 6 months were not significantly different. Conclusions: 1. The prevalence of PHG: 90.7%, the ratio of mild/severe PHG: 12.8%/87.2%. 2. EVL combined propranolol did not change significantly the prevalence, distribution and severity ofPHG in comparison with propranolol group. Key words: Cirrhosis, portal hypertensive gastropathy, esophageal variceal ligation, propranolol.

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Comparing the Effectiveness of Carvedilol and Propranolol to Prevent Reoccurrence of Esophageal Variceal Bleeding in Patients with Liver Cirrhosis.

10.53350/pjmhs211582491 ◽

2021 ◽

Vol 15 (8) ◽

pp. 2491-2493

Author(s):

Liaqat Khurshid ◽

Asadullah Khan ◽

Salim Hassan ◽

Adil Naseer Khan

Keyword(s):

Liver Cirrhosis ◽

Arterial Pressure ◽

Portal Vein ◽

Variceal Bleeding ◽

Esophageal Variceal ◽

Esophageal Variceal Bleeding ◽

Portal Vein Flow ◽

Group A ◽

Cirrhotic Patients ◽

Group B

Objective: To compare the efficacy of carvedilol and propranolol to prevent reoccurrence of esophageal variceal bleeding in patients with liver cirrhosis. Study Design: Place and Duration: Department of Gastroenterology and Hepatology, Ayub Teaching Hospital, Abbottabad, Pakistan for six months duration from 15th November 2020 to 15th May 2021. Methods: Total one hundred and forty patients of ages between 18-65 years were presented in this study. Patients detailed demographics age, sex, body mass index and Child-Turcotte-Pugh (CTP) class were recorded after taking written informed consent. Patients were equally (n=70) divided into two groups. Group A had 70 patients and received carvedilol while group B had 70 patients and received propranolol for 6 months. Reoccurrence ofesophageal variceal bleeding in cirrhotic patients among both groups were observed at 2nd, 4th and 6th months and patients pulse rate, arterial pressure and portal vein flow were recorded at these time points. Complete data was analyzed by SPSS 26.0 version. Results: Mean age of the patients in group A was 40.38 ± 5.87 years with mean BMI 28.09 ± 7.33 kg/m2 and in group B mean age was 39.43 ± 12.69 years with mean BMI 27.53 ± 8.84 kg/m2. In group A 45 (64.3%) patients were males and 25 (35.7%) were female patients while in group B 50 (71.43%) were male patients and 20 (28.7%) patients were females. We found that there was no statistically significant difference observed among both groups regarding these demographic variables. Reoccurrence of bleeding observed in group A was significantly lower (among 20 (28.6%) cases) as compared to group B (among 36 (51.43%) cases). Pulse rate, mean arterial pressure and portal vein flow was found lower in the carvedilol group as compared to propanol group with p value < 0.05 upon follow up at2,4 and 6 months. Conclusion: We found in this study that the drug carvedilol was more effective and safe to prevent reoccurrence of esophageal variceal bleeding in cirrhotic patients as compared to propanol. Keywords: Cirrhotic patients, Carvedilol, Propanol, Portal vein flow, Mean arterial pressure

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Use of nonselective β blockers after variceal eradication in cirrhotic patients undergoing secondary prophylaxis of esophageal variceal bleeding: a critical review of current evidence

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622319862693 ◽

2019 ◽

Vol 10 ◽

pp. 204062231986269 ◽

Cited By ~ 3

Author(s):

Xiangbo Xu ◽

Xiaozhong Guo ◽

Frank Tacke ◽

Xiaodong Shao ◽

Xingshun Qi

Keyword(s):

Variceal Bleeding ◽

Secondary Prophylaxis ◽

Endoscopic Surveillance ◽

Current Evidence ◽

Esophageal Variceal ◽

Esophageal Variceal Bleeding ◽

Cirrhotic Patients ◽

Β Blockers ◽

Variceal Recurrence ◽

Esophageal Variceal Ligation

Nonselective β blockers (NSBBs) combined with esophageal variceal ligation (EVL) are recommended for secondary prophylaxis of esophageal variceal bleeding (EVB) in cirrhotic patients according to the current practice guidelines and consensus. However, until now, there is a paucity of recommendations regarding the use of NSBBs in cirrhotic patients who achieved variceal eradication. In this review paper, we firstly introduced a case who achieved variceal eradication after additional use of NSBBs for secondary prophylaxis of EVB and then did not require further endoscopic therapy during repeated endoscopic surveillance, and subsequently discuss the importance of NSBBs for secondary prophylaxis of EVB, the effect of NSBBs after variceal eradication, adherence to NSBBs, screening for variceal recurrence, and timing of endoscopic surveillance after variceal eradication.

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