Primary prophylaxis of variceal bleeding in patients with cirrhosis: A comparison of different strategies.
| Autor: | de Mattos ÂZ; Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil. angmattos@hotmail.com., Terra C; Department of Internal Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950000, Brazil., Farias AQ; Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil., Bittencourt PL; Gastroenterology and Hepatology Unit, Hospital Português, Salvador 40140-901, Brazil. |
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| Jazyk: | angličtina |
| Zdroj: | World journal of gastrointestinal endoscopy [World J Gastrointest Endosc] 2021 Dec 16; Vol. 13 (12), pp. 628-637. |
| DOI: | 10.4253/wjge.v13.i12.628 |
| Abstrakt: | Patients with cirrhosis and esophageal varices bleed at a yearly rate of 5%-15%, and, when variceal hemorrhage develops, mortality reaches 20%. Patients are deemed at high risk of bleeding when they present with medium or large-sized varices, when they have red signs on varices of any size and when they are classified as Child-Pugh C and have varices of any size. In order to avoid variceal bleeding and death, individuals with cirrhosis at high risk of bleeding must undergo primary prophylaxis, for which currently recommended strategies are the use of traditional non-selective beta-blockers (NSBBs) ( i.e. , propranolol or nadolol), carvedilol (a NSBB with additional alpha-adrenergic blocking effect) or endoscopic variceal ligation (EVL). The superiority of one of these alternatives over the others is controversial. While EVL might be superior to pharmacological therapy regarding the prevention of the first bleeding episode, either traditional NSBBs or carvedilol seem to play a more prominent role in mortality reduction, probably due to their capacity of preventing other complications of cirrhosis through the decrease in portal hypertension. A sequential strategy, in which patients unresponsive to pharmacological therapy would be submitted to endoscopic treatment, or the combination of pharmacological and endoscopic strategies might be beneficial and deserve further investigation. Competing Interests: Conflict-of-interest statement: There are no conflicts of interest. (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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