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Indian Journal of Gastroenterology

, Volume 37, Issue 6, pp 563–564 | Cite as

Intermittent or continuous infusion of terlipressin for acute variceal bleeding—“cherry picking” to make it simpler

  • Cyriac Abby PhilipsEmail author
  • Philip Augustine
  • Rizwan Ahamed
  • Guruprasad Padsalgi
  • Amal Jose
  • Sasidharan Rajesh
Letter
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Sir,

We congratulate Jha and colleagues for their recently published study in the Journal that compared continuous infusion (CI) vs. intermittent boluses (IB) of terlipressin in patients with acute variceal bleeding (AVB) [1]. The authors concluded that CI of terlipressin may be more effective than intermittent infusion in preventing treatment failure in patients with AVB. There are certain “elephant in the room” issues that need to be addressed with respect to the study and its conclusions. Jha et al. have not mentioned the inclusion/exclusion of acute-on-chronic liver failure (ACLF) patients in the study. From Table 2, one can notice that the highest total bilirubin levels in the CI and IB groups are 21 and 17 mg/dL, respectively, which is not easily explained by simple decompensation in the natural history of cirrhosis. Since alcoholic liver disease formed a majority of patients, the timing of last alcohol use, ongoing alcoholism, and severity of alcoholic hepatitis could have led...

Notes

Compliance with ethical standards

Conflict of interest

CAP, PA, RA, GP, AJ, and SR declare that they have no conflict of interest.

Disclaimer

The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/ findings and content of this article.

References

  1. 1.
    Jha SK, Mishra M, Jha A, Dayal VM. Comparison of continuous versus intermittent infusions of terlipressin for the control of acute variceal bleeding in patients with portal hypertension: an open-label randomized controlled trial. Indian J Gastroenterol. 2018;37:313–20.CrossRefGoogle Scholar
  2. 2.
    Gioia S, Nardelli S, Pasquale C, et al. Natural history of patients with non-cirrhotic portal hypertension: comparison with patients with compensated cirrhosis. Dig Liver Dis. 2018;50:839–44.Google Scholar
  3. 3.
    Ventura-Cots M, Carmona I, Moreno C, et al. Duration of the acute hepatic encephalopathy episode determines survival in cirrhotic patients. Therap Adv Gastroenterol. 2018;11:1756283X17743419.CrossRefGoogle Scholar
  4. 4.
    Bajaj JS, O’Leary JG, Tandon P, et al. Hepatic encephalopathy is associated with mortality in patients with cirrhosis independent of other extrahepatic organ failures. Clin Gastroenterol Hepatol. 2017;15:565–74.CrossRefGoogle Scholar
  5. 5.
    Yoo W, Mayberry R, Bae S, Singh K, He QP, Lillard JW. A study of effects of multicollinearity in the multivariable analysis. Int J Appl Sci Technol. 2014;4:9–19.Google Scholar

Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  • Cyriac Abby Philips
    • 1
    Email author
  • Philip Augustine
    • 1
  • Rizwan Ahamed
    • 1
  • Guruprasad Padsalgi
    • 1
  • Amal Jose
    • 1
  • Sasidharan Rajesh
    • 1
  1. 1.Gastroenterology and the Liver Unit, Cochin Gastroenterology GroupErnakulam Medical CentreKochiIndia

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