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Patients whose first episode of bleeding occurs while taking a β-blocker have high long-term risks of rebleeding and death.
- Source :
-
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2012 Jun; Vol. 10 (6), pp. 670-6; quiz e58. Date of Electronic Publication: 2012 Feb 22. - Publication Year :
- 2012
-
Abstract
- Background & Aims: Patients who have their first episode of variceal bleeding despite primary prophylaxis with a nonselective β-adrenergic receptor antagonist (also called a nonselective β-blocker [NSBB]) receive additional treatment by endoscopic band ligation to prevent further bleeding. However, little is known about their long-term outcomes.<br />Methods: We collected data on 89 consecutive patients with cirrhosis who were admitted to the Liver Unit of Hospital Clínic, Barcelona, with acute esophageal variceal bleeding between June 2007 and February 2011. Thirty-four patients were receiving primary prophylaxis with NSBBs when they had their first episode of variceal bleeding, whereas 55 were not receiving NSBBs (controls). All patients were subsequently treated with a combination of endoscopic band ligation and NSBBs. Patients were examined after 1, 3, and 6 months and every 6 months thereafter until 2 years.<br />Results: After 2 years, a greater proportion of patients who had their first episode of bleeding while on NSBBs had further bleeding, compared with controls (48% vs 24%; P = .01). Primary prophylaxis with NSBBs and serum levels of bilirubin were independent predictors of rebleeding. Overall, 11 patients died, and 5 underwent liver transplantation. Liver transplantation-free survival was lower among patients who had their first episode of bleeding while taking NSBBs (66% vs 88% for controls; P = .02). Primary prophylaxis with NSBBs and Child-Pugh class were independently associated with liver transplantation-free survival.<br />Conclusions: Patients who have their first episode of variceal bleeding while on primary prophylaxis with a β-blocking agent have an increased risk of further bleeding and death, despite adding endoscopic band ligation. These patients possibly require alternative treatment approaches.<br /> (Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Female
Humans
Male
Middle Aged
Recurrence
Risk Assessment
Spain epidemiology
Survival Analysis
Treatment Outcome
Adrenergic beta-Antagonists administration & dosage
Adrenergic beta-Antagonists adverse effects
Esophageal Diseases epidemiology
Esophageal Diseases mortality
Hemorrhage epidemiology
Hemorrhage mortality
Liver Cirrhosis complications
Subjects
Details
- Language :
- English
- ISSN :
- 1542-7714
- Volume :
- 10
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
- Publication Type :
- Academic Journal
- Accession number :
- 22366180
- Full Text :
- https://doi.org/10.1016/j.cgh.2012.02.011