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TIPSS for variceal bleeding in patients with idiopathic non-cirrhotic portal hypertension: comparison with patients who have cirrhosis
- Source :
- Alimentary pharmacologytherapeutics. 49(7)
- Publication Year :
- 2018
-
Abstract
- Background In patients with idiopathic non-cirrhotic portal hypertension (INCPH), the usual recommended strategy for management of variceal bleeding is the same as that in cirrhosis. However, this policy has been challenged by the different natural history between INCPH and cirrhosis. Aim To compare outcomes after transjugular intrahepatic portosystemic shunt (TIPSS) between INCPH and cirrhotic patients admitted for variceal bleeding. Methods Between March 2001 and September 2015, 76 consecutive patients with biopsy-proven INCPH undergoing TIPSS for variceal bleeding in a tertiary-care centre were included. 76 patients with cirrhotic portal hypertension receiving TIPSS for variceal bleeding, and matched for age, sex, Child-Pugh class, stent type and index year of TIPSS creation served as controls. Results Patients with INCPH, compared to those with cirrhosis, had significantly lower mortality (11% vs 36% at 5 years, adjusted HR, 0.37; 95% CI 0.15-0.87, P = 0.022), overt hepatic encephalopathy (16% vs 33% at 5 years, adjusted HR, 0.35; 95% CI 0.16-0.75, P = 0.007) and hepatic impairment, despite similar rates of further bleeding (33% vs 32% at 5 years, adjusted HR, 0.72; 95% CI 0.36-1.44, P = 0.358), and shunt dysfunction (35% vs 36% at 5 years, adjusted HR, 0.84; 95% CI 0.41-1.72, P = 0.627). These findings were consistent across different relevant subgroups. Conclusions Patients with INCPH treated with TIPSS for variceal bleeding had similar progression of portal hypertension (further bleeding and shunt dysfunction) but fewer complications of liver disease (overt hepatic encephalopathy and hepatic insufficiency) and lower mortality rate compared with cirrhotic patients with comparable liver function.
- Subjects :
- Adult
Liver Cirrhosis
Male
medicine.medical_specialty
Cirrhosis
medicine.medical_treatment
Esophageal and Gastric Varices
Gastroenterology
03 medical and health sciences
Liver disease
Young Adult
0302 clinical medicine
Internal medicine
Hypertension, Portal
Medicine
Humans
Pharmacology (medical)
030212 general & internal medicine
Young adult
Hepatic encephalopathy
Aged
Hepatology
business.industry
Stent
Middle Aged
medicine.disease
Hepatic Encephalopathy
Portal hypertension
030211 gastroenterology & hepatology
Female
Stents
Liver function
Portasystemic Shunt, Transjugular Intrahepatic
business
Gastrointestinal Hemorrhage
Transjugular intrahepatic portosystemic shunt
Follow-Up Studies
Subjects
Details
- ISSN :
- 13652036
- Volume :
- 49
- Issue :
- 7
- Database :
- OpenAIRE
- Journal :
- Alimentary pharmacologytherapeutics
- Accession number :
- edsair.doi.dedup.....10b415a5f144d275526ca81d3dac9519