Variceal bleeding

  • T. Sauerbruch
  • J. Trebicka
Conference paper
Part of the Falk Symposium book series (FASS, volume 160)

Abstract

Variceal bleeding is caused by portal hypertension, which can be assessed by measurement of the gradient between the wedged hepatic venous pressure and the free hepatic venous pressure (HVPG). A threshold of 10 mmHg is associated with the formation of collaterals to bypass splanchnic venous blood through the liver1,2.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Le Moine O, Hadengue A, Moreau R et al. Relationship between portal pressure. esophageal varices, and variceal bleeding on the basis of the stage and cause of cirrhosis. Scand J Gastroenterol. 1997;32:731–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Groszmann RJ, Garcia-Tsao G, Bosch J et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med. 2005;353:2254–61.PubMedCrossRefGoogle Scholar
  3. 3.
    Rigau J, Bosch J, Bordas JM et al. Endoscopic measurement of variceal pressure in cirrhosis: correlation with portal pressure and variceal hemorrhage. Gastroenterology. 1989;96:873–80.PubMedGoogle Scholar
  4. 4.
    Garcia-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE, Glickman M. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985;5:419–24.PubMedCrossRefGoogle Scholar
  5. 5.
    Barton R, Rosch J, Saxon R, Lakin P. TIPS: short-and long-term results; a survey of 1750 patients. Semin Intervent Radiol. 1995:364–7.Google Scholar
  6. 6.
    McCormick PA, O’Keefe C. Improving prognosis following a first variceal haemorrhage over four decades. Gut. 2001;49:682–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Carbonell N, Pauwels A, Serfaty L, Fourdan O, Levy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 2004;40:652–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Merkel C, Marin R, Angeli P et al. A placebo-controlled clinical trial of nadolol in the prophylaxis of growth of small esophageal varices in cirrhosis. Gastroenterology. 2004;127:476–84.PubMedCrossRefGoogle Scholar
  9. 9.
    Trebicka J, Hennenberg M, Laleman W et al. Atorvastatin lowers portal pressure in cirrhotic rats by inhibition of RhoA/Rho-kinase and activation of endothelial nitric oxide synthase. Hepatology. 2007;46:242–53.PubMedCrossRefGoogle Scholar
  10. 10.
    Trebicka J, Neef M, Hennenberg M et al. Atorvastatin inhibits fibrogenesis through inhibition of activation of hepatic stellate cells. J Hepatol. 2007;46:S134.CrossRefGoogle Scholar
  11. 11.
    Zafra C, Abraldes JG, Turnes J et al. Simvastatin enhances hepatic nitric oxide production and decreases the hepatic vascular tone in patients with cirrhosis. Gastroenterology. 2004;126:749–55.PubMedCrossRefGoogle Scholar
  12. 12.
    Schepke M, Werner E, Biecker E et al. Hemodynamic effects of the angiotensin II receptor antagonist irbesartan in patients with cirrhosis and portal hypertension. Gastroenterology. 2001;121:389–95.PubMedCrossRefGoogle Scholar
  13. 13.
    Croquet V, Moal F, Veal N et al. Hemodynamic and antifibrotic effects of losartan in rats with liver fibrosis and/or portal hypertension. J Hepatol. 2002;37:773–80.PubMedCrossRefGoogle Scholar
  14. 14.
    Sookoian S, Fernandez MA, Castano G. Effects of six months losartan administration on liver fibrosis in chronic hepatitis C patients: a pilot study. World J Gastroenterol. 2005;11:7560–3.PubMedGoogle Scholar
  15. 15.
    Rincon D, Ripoll C, Lo Iacono O et al. Antiviral therapy decreases hepatic ven ous pressure gradient in patients with chronic hepatitis C and advanced fibrosis. Am J Gastroenterol. 2006;101:2269–74.PubMedCrossRefGoogle Scholar
  16. 16.
    Trebicka J, Leifeld L, Hennenberg M et al. Hemodynamic effects of urotensin II and its specific receptor antagonist palosuran in cirrhotic rats. Hepatology. 2008;47:1264–76.PubMedCrossRefGoogle Scholar
  17. 17.
    North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med. 1988:319:983–9.Google Scholar
  18. 18.
    Kleber G, Sauerbruch T, Fischer G, Paumgartner G. Pressure of intraoesophageal varices assessed by fine needle puncture: its relation to endoscopic signs and severity of liver disease in patients with cirrhosis. Gut. 1989;30:228–32.PubMedCrossRefGoogle Scholar
  19. 19.
    Poynard T, Cales P, Pasta L, Ideo G, Pascal JP, Pagliaro L, Lebrec D. Beta-adrenergic-antagonist drugs in the prevention of gastrointestinal bleeding in patients with cirrhosis and esophageal varices. An analysis of data and prognostic factors in 589 patients from four randomized clinical trials. Franco-Italian Multicenter Study Group. N Engl J Med. 1991;324:1532–8.PubMedGoogle Scholar
  20. 20.
    Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology. 2001;120:726–48.PubMedCrossRefGoogle Scholar
  21. 21.
    Khuroo MS, Khuroo NS, Farahat KL, Khuroo YS, Sofi AA, Dahab ST. Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding. Aliment Pharmacol Ther. 2005;21:347–61.PubMedCrossRefGoogle Scholar
  22. 22.
    Schepke M, Kleber G, Nurnberg D et al. Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology. 2004;40:65–72.PubMedCrossRefGoogle Scholar
  23. 23.
    Banares R, Moitinho E, Piqueras B et al. Carvedilol, a new nonselective beta-blocker with intrinsic anti-alpha1-adrenergic activity, has a greater portal hypotensive effect than propranolol in patients with cirrhosis. Hepatology. 1999;30:79–83.PubMedCrossRefGoogle Scholar
  24. 24.
    Ioannou GN, Kowdley KV. Review: Antibiotic prophylaxis reduces mortality and bacterial infection in cirrhosis and gastrointestinal bleeding. ACP J Club. 2002;137:94.PubMedGoogle Scholar
  25. 25.
    de Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2005;43:167–76.PubMedCrossRefGoogle Scholar
  26. 26.
    Sung JJ, Chung SC, Yung MY et al. Prospective randomised study of effect of octreotide on rebleeding from oesophageal varices after endoscopic ligation. Lancet. 1995;346:1666–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Cales P, Masliah C, Bernard B et al. Early administration of vapreotide for variceal bleeding in patients with cirrhosis. N Engl J Med. 2001;344:23–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Garcia-Pagan JC, Bosch J. Endoscopic band ligation in the treatment of portal hypertension. Nat Clin Pract Gastroenterol Hepatol 2005;2:526–35.PubMedCrossRefGoogle Scholar
  29. 29.
    Gross M, Schiemann U, Muhlhofer A, Zoller WG. Meta-analysis: efficacy of therapeutic regimens in ongoing variceal bleeding. Endoscopy. 2001;33:737–46.PubMedCrossRefGoogle Scholar
  30. 30.
    Bernard B, Grange JD, Khac EN, Amiot X, Opolon P, Poynard T. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology. 1999;29:1655–61.PubMedCrossRefGoogle Scholar
  31. 31.
    Bernard B, Lebrec D, Mathurin P, Opolon P, Poynard T. Beta-adrenergic antagonists in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis. Hepatology. 1997;25:63–70.PubMedCrossRefGoogle Scholar
  32. 32.
    de la Pena J, Brullet E, Sanchez-Hernandez E et al. Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: a multicenter trial. Hepatology. 2005;41:572–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Study Group Spanish Cooperative Variceal Rebleeding. Multicenter RCT comparing drug therapy vs combination of drug therapy+endoscopic variceal ligation in the prevention of rebleeding in patients with cirrhosis. Hepatology. 2006;44:202A.Google Scholar
  34. 34.
    Villanueva C, Minana J, Ortiz J et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding. N Engl J Med. 2001;345:647–55.PubMedCrossRefGoogle Scholar
  35. 35.
    Henderson JM, Boyer TD, Kutner MH et al. DIVERT Study Group. Distal splenorenal shunt versus transjugular intrahepatic portal systematic shunt for variceal bleeding: a randomized trial. Gastroenterology. 2006;130:1643–51.PubMedCrossRefGoogle Scholar

Copyright information

© Springer and Falk Foundation e.V. 2008

Authors and Affiliations

  • T. Sauerbruch
    • 1
  • J. Trebicka
  1. 1.Medizinische Klinik und Poliklinik IUniversity of BonnBonnGermany

Personalised recommendations