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

BACKGROUND: Acute esophageal variceal bleeding (EVB) is a major cause of morbidity and mortality in patients with liver cirrhosis. Guidelines have been published in 1997; however, variability in the acute management and prevention of EVB rebleeding may occur.METHODS: Gastroenterologists in the provinces of British Columbia, Alberta, Manitoba and Saskatchewan were sent a self-reporting questionnaire.RESULTS: The response rate was 70.4% (86 of 122). Intravenous octreotide was recommended by 93% for EVB patients but the duration was variable. The preferred timing for endoscopy in suspected acute EVB was within 12 h in 75.6% of respondents and within 24 h in 24.6% of respondents. Most (52.3%) gastroenterologists do not routinely use antibiotic prophylaxis in acute EVB patients. The preferred duration of antibiotic therapy was less than three days (35.7%), three to seven days (44.6%), seven to 10 days (10.7%) and throughout hospitalization (8.9%). Methods of secondary prophylaxis included repeat endoscopic therapy (93%) and beta-blocker therapy (84.9%). Most gastroenterologists (80.2%) routinely attempted to titrate beta-blockers to a heart rate of 55 beats/min or a 25% reduction from baseline. The most common form of secondary prophylaxis was a combination of endoscopic and pharmacological therapy (70.9%).CONCLUSIONS: Variability exists in some areas of EVB treatment, especially in areas for which evidence was lacking at the time of the last guideline publication. Gastroenterologists varied in the use of prophylactic antibiotics for acute EVB. More gastroenterologists used combination secondary prophylaxis in the form of band ligation eradication and beta-blocker therapy rather than either treatment alone. Future guidelines may be needed to address these practice differences.

Download Full-text

239 INFLUENCE OF BMI ON THE RESPONSE TO BETA-BLOCKER THERAPY IN PRIMARY AND SECONDARY PROPHYLAXIS OF VARICEAL BLEEDING IN LIVER CIRRHOSIS

Journal of Hepatology ◽

10.1016/s0168-8278(13)60241-x ◽

2013 ◽

Vol 58 ◽

pp. S103

Author(s):

P. Salzl ◽

P. Schwabl ◽

T. Reiberger ◽

B.A. Payer ◽

M. Ferlitsch ◽

...

Keyword(s):

Liver Cirrhosis ◽

Beta Blocker ◽

Variceal Bleeding ◽

Secondary Prophylaxis ◽

Blocker Therapy ◽

Beta Blocker Therapy

Download Full-text

EFFICACY OF CARVEDILOL COMBINED WITH ENDOSCOPIC VARICEAL LIGATION IN THE PREVENTION OF RECURRENT VARICEAL BLEEDING IN PATIENTS OF CIRRHOSIS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2016.1.3 ◽

2016 ◽

pp. 23-30

Author(s):

Van Huy Tran ◽

Thi Ngoc Diep Bui

Keyword(s):

Side Effects ◽

Beta Blocker ◽

Variceal Bleeding ◽

Poor Prognosis ◽

Oesophageal Varices ◽

Endoscopic Variceal Ligation ◽

Efficacy And Safety ◽

Orthostatic Hypertension ◽

Key Words Carvedilol ◽

Very High

Background: The recurrent variceal bleeding is still very high with a very poor prognosis. The combination of a non-selective beta-blocker and endoscopic variceal ligation (EVL) is still a standard therapy for the prevention, but many patients showed no response to propranolol. Carvedilol is a new, non-selective beta-blocker having intrinsic alpha-blocker activity, but the data about the efficacy and safety of carvedilol is still very limited. This study is aimed at assessing the efficacy and safety of carvedilol combined with EVL in the prevention of recurrent variceal bleeding. Patients and methods: 33 patients having variceal bleeding were enrolled. All patients received carvedilol and were performed the EVL until variceal eradication. All the patients were followed after 9 months. Results: rate of variceal eradication of oesophageal varices was 87.88%; the recurrence rate of variceal bleeding was 12.12% after 9 months. The side effects of carvedilol were rare and not severe, including vertiges, headache, and orthostatic hypertension. Conclusion: Carvedilol combined with EVL appeared as a relatively safe and effective in the prevention of recurrent variceal bleeding in patients of cirrhosis. Key words: carvedilol, variceal bleeding, EVL

Download Full-text