Perceptions on the management of varices and on the use of albumin in patients with cirrhosis among GI specialists in Austria.

Autor: Pfisterer N; Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna General Hospital and Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.; 4. Medizinische Abteilung für Gastroenterologie und Hepatologie, Klinik Landstraße / Krankenanstalt Rudolfstiftung, Wien, Austria., Schmidbauer C; Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna General Hospital and Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.; 4. Medizinische Abteilung für Gastroenterologie und Hepatologie, Klinik Ottakring / Wilhelminenspital, Wien, Austria., Riedl F; Klinische Abteilung für Innere Medizin 2, Universitätsklinikum St. Pölten, St. Pölten, Austria., Maieron A; Klinische Abteilung für Innere Medizin 2, Universitätsklinikum St. Pölten, St. Pölten, Austria., Stadlbauer V; Klinische Abteilung für Gastroenterologie und Hepatologie, LKH-Univ. Klinikum Graz, Graz, Austria., Hennlich B; 4. Medizinische Abteilung für Gastroenterologie und Hepatologie, Klinik Landstraße / Krankenanstalt Rudolfstiftung, Wien, Austria., Schwarzer R; Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna General Hospital and Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria., Puespoek A; Abteilung für Innere Medizin II, Krankenhaus der Barmherzigen Brüder, Eisenstadt, Austria., Bucsics T; Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna General Hospital and Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria., Effenberger M; Abteilung für Innere Medizin I, Universitätsklinikum Innsbruck, Innsbruck, Austria., Bota S; Innere Medizin und Gastroenterologie (IMuG) mit zentraler Aufnahme und Erstversorgung (ZAE), Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria., Gschwantler M; 4. Medizinische Abteilung für Gastroenterologie und Hepatologie, Klinik Ottakring / Wilhelminenspital, Wien, Austria.; Fakultät für Medizin, Sigmund Freud Universität Wien, Wien, Austria., Peck-Radosavljevic M; Innere Medizin und Gastroenterologie (IMuG) mit zentraler Aufnahme und Erstversorgung (ZAE), Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria., Mandorfer M; Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna General Hospital and Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria., Madl C; 4. Medizinische Abteilung für Gastroenterologie und Hepatologie, Klinik Landstraße / Krankenanstalt Rudolfstiftung, Wien, Austria.; Fakultät für Medizin, Sigmund Freud Universität Wien, Wien, Austria., Trauner M; Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna General Hospital and Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria., Reiberger T; Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna General Hospital and Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. thomas.reiberger@meduniwien.ac.at.; Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria. thomas.reiberger@meduniwien.ac.at.; Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria. thomas.reiberger@meduniwien.ac.at.
Jazyk: angličtina
Zdroj: Wiener klinische Wochenschrift [Wien Klin Wochenschr] 2021 May; Vol. 133 (9-10), pp. 421-431. Date of Electronic Publication: 2020 Dec 03.
DOI: 10.1007/s00508-020-01769-9
Abstrakt: Background: Portal hypertension (PH) causes severe complications in patients with liver cirrhosis, such as variceal bleeding and ascites; however, data on the knowledge and perceptions on guideline recommendations for the management of varices and the use of albumin is scarce.
Methods: We designed two structured surveys on (i) the management of varices and (ii) the use of albumin for Austrian physicians of specialized Gastro-Intestinal (GI) centers. The interviewed physicians were confronted spontaneously and provided ad hoc responses to the questionnaire.
Results: In total, 158 surveys were completed. Interestingly, many specialists (30%) would recommend a follow-up gastroscopy after 1 year in patients with compensated cirrhosis without varices (i.e., overtreatment). For small varices, 81.5% would use non-selective beta blockers (NSBB) for primary prophylaxis (PP). For PP in patients with large varices, endoscopic band ligation (EBL) plus NSBB was preferred by 51.4% (i.e., overtreatment). Knowledge on the indication criteria for early TIPS (transjugular intrahepatic portosystemic shunt) was reported by 54.3%, but only 20% could report these criteria correctly. The majority (87.1%) correctly indicated a preference to use NSBB and EBL for secondary prophylaxis (SP). The majority of participating gastroenterologists reported no restrictions on the use of albumin (89.8%) in their hospitals. Of the interviewed specialists, 63.6% would use albumin in patients with SBP; however, only 11.4% would use the doses recommended by guidelines. The majority of specialists indicated using albumin at the recommended doses for hepatorenal syndrome (HRS-AKI, 86.4%) and for large volume paracentesis (LVP, 73.3%). The individual responses regarding albumin use for infections/sepsis, hyponatremia, renal impairment, and encephalopathy were heterogeneous.
Conclusion: The reported management of PH and varices is mostly adherent to guidelines, but endoscopic surveillance in patients without varices is too intense and EBL is overused in the setting of PP. Knowledge on the correct use of early TIPS must be improved among Austrian specialists. Albumin use is widely unrestricted in Austria; however, albumin is often underdosed in established indications.
Databáze: MEDLINE
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