Clinical vs haemodynamic response to drugs in portal hypertension
| Autor: | David Patch, J. K. T. Chin, Neil McIntyre, Andrew K. Burroughs, P. Aiden McCormick, Lynda Greenslade |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Liver Cirrhosis
Male medicine.medical_specialty Cirrhosis Time Factors Haemodynamic response medicine.medical_treatment Portal venous pressure Vasodilator Agents Adrenergic beta-Antagonists Blood Pressure Isosorbide Dinitrate Esophageal and Gastric Varices Octreotide Liver Cirrhosis Alcoholic Recurrence Internal medicine Hypertension Portal Sclerotherapy medicine Humans Varix Hepatology Vascular disease business.industry Hemodynamics Middle Aged medicine.disease Propranolol Surgery Treatment Outcome Cardiology Portal hypertension Female business Varices Follow-Up Studies |
| Zdroj: | Journal of hepatology. 28(6) |
| ISSN: | 0168-8278 |
| Popis: | Background/Aims: The combination of non-selective beta-blockers and nitrates is an effective therapy for the prevention of rebleeding from oesophageal varices. However, a significant number of patients fail to respond and have further haemorrhage. It has been suggested that measurement of the hepatic venous pressure gradient response to long-term drug therapy may allow early selection of non-responders. We aimed to test this hypothesis in 63 patients with cirrhosis and variceal bleeding treated with propranolol±isosorbide mononitrate. Methods: Hepatic venous pressure gradient was measured before and during treatment. Response was defined as a reduction of 20% or more in hepatic venous pressure gradient, or a fall in hepatic venous pressure gradient to 12 mmHg or less. Results: Forty-four patients were evaluable: 28 responders and 16 non-responders. Hepatic venous pressure gradient fell significantly in the responder group (17.5±0.5 mmHg vs 12.2±0.5 mmHg; p p =n.s.). Overall, there was no difference in rebleeding rates between the two groups: responders 43%, non-responders 25%. However, rebleeding was uncommon in compliant patients with alcoholic cirrhosis, in whom the hepatic venous pressure gradient fell to less than 12 mmHg (9%). Conclusions: In this study a fall in hepatic venous pressure gradient at 20% was not a reliable predictor of clinical response. A threshold value of 12 mmHg was useful, but applied to relatively few patients. |
| Databáze: | OpenAIRE |
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