Perceptions on the management of varices and on the use of albumin in patients with cirrhosis among GI specialists in Austria
| Autor: | F. Riedl, Markus Peck-Radosavljevic, Nikolaus Pfisterer, Andreas Puespoek, Mattias Mandorfer, Theresa Bucsics, Michael Gschwantler, Vanessa Stadlbauer, Barbara Hennlich, Christian Madl, Simona Bota, Thomas Reiberger, Andreas Maieron, Caroline Schmidbauer, Remy Schwarzer, Maria Effenberger, Michael Trauner |
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| Rok vydání: | 2020 |
| Předmět: |
Liver Cirrhosis
0301 basic medicine medicine.medical_specialty Cirrhosis medicine.medical_treatment Non-selective beta blockers Esophageal and Gastric Varices Transjugular intrahepatic portosystemic shunt Varicose Veins 03 medical and health sciences 0302 clinical medicine Hepatorenal syndrome Albumins Internal medicine Ascites medicine Humans Survey Practice business.industry Albumin General Medicine Guideline medicine.disease 030104 developmental biology Austria Portal hypertension Original Article 030211 gastroenterology & hepatology medicine.symptom Gastrointestinal Hemorrhage Varices business Hyponatremia Specialization |
| Zdroj: | Wiener Klinische Wochenschrift |
| ISSN: | 1613-7671 0043-5325 |
| Popis: | Summary 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: | OpenAIRE |
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