Intermittent or continuous infusion of terlipressin for acute variceal bleeding—“cherry picking” to make it simpler
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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) . 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...
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CAP, PA, RA, GP, AJ, and SR declare that they have no conflict of interest.
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.
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