1. Beneficial long term effect of a phosphodiesterase-5-inhibitor in cirrhotic portal hypertension: A case report with 8 years follow-up.
- Author
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Deibert P, Lazaro A, Stankovic Z, Schaffner D, Rössle M, and Kreisel W
- Subjects
- Administration, Oral, Cholangitis, Sclerosing diagnostic imaging, Cholangitis, Sclerosing pathology, Computed Tomography Angiography, Endoscopy, Digestive System, Esophageal and Gastric Varices diagnostic imaging, Esophageal and Gastric Varices etiology, Esophageal and Gastric Varices surgery, Female, Follow-Up Studies, Gastrointestinal Hemorrhage diagnostic imaging, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage surgery, Hemodynamics drug effects, Hepatitis, Autoimmune diagnostic imaging, Hepatitis, Autoimmune pathology, Humans, Hypertension, Portal diagnostic imaging, Hypertension, Portal etiology, Hypertension, Portal pathology, Liver Cirrhosis diagnostic imaging, Liver Cirrhosis etiology, Liver Cirrhosis pathology, Middle Aged, Phosphodiesterase 5 Inhibitors pharmacology, Syndrome, Tadalafil pharmacology, Tadalafil therapeutic use, Time Factors, Treatment Outcome, Vardenafil Dihydrochloride pharmacology, Vardenafil Dihydrochloride therapeutic use, Cholangitis, Sclerosing complications, Hepatitis, Autoimmune complications, Hypertension, Portal drug therapy, Liver Cirrhosis drug therapy, Phosphodiesterase 5 Inhibitors therapeutic use
- Abstract
Non-selective beta-blockers are the mainstay of medical therapy for portal hypertension in liver cirrhosis. Inhibitors of phosphodiesterase-5 (PDE-5-inhibitors) reduce portal pressure in the acute setting by > 10% which may suggest a long-term beneficial effect. Currently, there is no available data on long-term treatment of portal hypertension with PDE-5-inhibitors. This case of a patient with liver cirrhosis secondary to autoimmune liver disease with episodes of bleeding from esophageal varices is the first documented case in which a treatment with a PDE-5-inhibitor for eight years was monitored. In the acute setting, the PDE-5-inhibitor Vardenafil lowered portal pressure by 13%. The portal blood flow increased by 28% based on Doppler sonography and by 16% using MRI technique. As maintenance medication the PDE-5-inhibitor Tadalafil was used for eight consecutive years with comparable effects on portal pressure and portal blood flow. There were no recurrence of bleeding and no formation of new varices. Influencing the NO-pathway by the use of PDE-5 inhibitors may have long-term beneficial effects in compensated cirrhosis., Competing Interests: Conflict-of-interest statement: None of the authors declared a conflict of interest.
- Published
- 2018
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