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Pharmacological reduction of portal pressure and long-term risk of first variceal bleeding in patients with cirrhosis
- Source :
- The American journal of gastroenterology. 101(3)
- Publication Year :
- 2006
-
Abstract
- A reduction in hepatic venous pressure gradient (HVPG) ofor =20% of baseline or toor =12 mmHg (responders) is associated with a reduced risk of first variceal bleeding. The aim of this study was to evaluate whether this protective effect is maintained in the long term and if it extends to other portal hypertension complications.Seventy-one cirrhotic patients with esophageal varices and without previous variceal bleeding who entered into a program of prophylactic pharmacological therapy and were followed for up to 8 yr were evaluated. All had two separate HVPG measurements, at baseline and after pharmacological therapy with propranolol +/- isosorbide mononitrate.Forty-six patients were nonresponders and 25 were responders. Eight-year cumulative probability of being free of first variceal bleeding was higher in responders than in nonresponders (90% vs 45%, p= 0.026). The lack of hemodynamic response and low platelet count were the only independent predictors of first variceal bleeding. Additionally, reduction of HVPG was independently associated with a decreased risk of spontaneous bacterial peritonitis (SBP) or bacteremia. No significant differences in the development of ascites, hepatic encephalopathy, or survival were observed.The hemodynamic response in cirrhotic patients is associated with a sustained reduction in the risk of first variceal bleeding over a long-term follow-up. Reduction of HVPG also correlate with a reduced risk of SBP or bacteremia.
- Subjects :
- Adult
Liver Cirrhosis
Male
Risk
medicine.medical_specialty
Cirrhosis
Portal venous pressure
Peritonitis
Esophageal and Gastric Varices
Gastroenterology
Internal medicine
Cause of Death
Hypertension, Portal
medicine
Humans
Risk factor
Hepatic encephalopathy
Aged
Varix
Hepatology
business.industry
Vascular disease
Bacterial Infections
Middle Aged
medicine.disease
Long-Term Care
Portal Pressure
Survival Rate
Hepatic Encephalopathy
Portal hypertension
Female
Varices
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 00029270
- Volume :
- 101
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- The American journal of gastroenterology
- Accession number :
- edsair.doi.dedup.....cd6d610aeb6c62ccf8e734f9676a176c