Beta-adrenergic-antagonist drugs in the prevention of gastrointestinal bleeding in patients with cirrhosis and esophageal varices: an analysis of data and prognostic factors in 589 patients from four randomized clinical trials

Article Abstract:

Cirrhosis of the liver can result in an increase in blood pressure in the portal vein, which carries blood from the intestines to the liver. This increased portal pressure can, in turn, contribute to the development of esophageal varices. A varix is an abnormally tortuously twisted vein; esophageal varices can result in serious bleeding directly into the digestive cavity. Indeed, gastrointestinal bleeding is a major cause of death among patients with esophageal varices. Drugs, such as beat-adrenergic-antagonist drugs (beta blockers), which have the effect of reducing the pressure in the portal vein, might be useful in the management of patients with liver cirrhosis and esophageal varices. However, some studies have indicated a beneficial effect, while others determined that not all patients benefitted from the treatment. To clarify the efficacy of these drugs, a study was undertaken involving 589 patients with liver cirrhosis and esophageal varices. A total of 203 patients received the beta-adrenergic-antagonist drug propranolol and 83 received the related drug nadolol. The remaining 303 patients were given a placebo. After two years, 18 percent of the patients receiving only placebo had suffered fatal internal bleeding. In contrast, fatal episodes of bleeding occurred in only 10 percent of the patients treated with the beta-adrenergic antagonists. Seventy-eight percent of the treated patients survived the two-year period without an episode of bleeding, in contrast with 65 percent of the patients given only placebo. The study also found that the risk of death by gastrointestinal bleeding increased with the increasing severity of the cirrhosis. Furthermore, the risk was also increased in those patients with ascites, excessive fluid secretions in the abdominal cavity. However, it was clear that the drug treatment was effective in reducing the risk of bleeding and death, even when only the most severely affected patients were considered. The results confirm that the beta-adrenergic-antagonist drugs propranolol and nadolol are effective in reducing the risk of internal bleeding and death from internal bleeding in patients with liver cirrhosis, regardless of the severity of disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Gastrointestinal bleeding, Gastrointestinal hemorrhage, Adrenergic beta blockers, Adrenergic beta-antagonists, Portal hypertension

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Sclerotherapy with or without octreotide for acute variceal bleeding

Article Abstract:

The combination of sclerotherapy and octreotide may be more effective than sclerotherapy alone in treating variceal bleeding but may not improve survival rates. Sclerotherapy is the administration of hardening agents which reduce bleeding in enlarged or twisted blood vessels called varices. Of 199 patients with cirrhosis and variceal bleeding who received sclerotherapy, 101 received a placebo and 98 received 25 microgram per hour of octreotide for five days. After five days, 87% of the octreotide group and 71% of the placebo group survived without bleeding again. In addition, the average number of blood transfusions in the first 24 hours after sclerotherapy was 1.2 units in the octreotide group, and 2.0 units in the placebo group. After 15 days, uncontrolled bleeding or death occurred in 13 people in the octreotide group and 29 of those in the placebo group. However, the survival rate in each group was approximately 88% after 15 days.

Health aspects, Octreotide acetate, Sclerotherapy

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Early administration of vapreotide for variceal bleeding in patients with cirrhosis

Article Abstract:

The use of vapreotide in addition to endoscopic treatment is more effective than endoscopic treatment alone in treating esophageal bleeding caused by liver cirrhosis, according to a study of 227 patients. Vapreotide is a drug that mimics the action of somatostatin.

Injuries, Hemorrhage

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