Managing Varices: Drugs, Bands, and Shunts

Gastroenterology Clinics of North America

Volumn 40, Issue 3, 2011, Pages 561-579

  Opio, Christopher Kenneth ^a,b   Garcia Tsao, Guadalupe ^a,b  

^a YALE UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b VA CONNECTICUT HEALTHCARE SYSTEM   (United States)

Author keywords

Ligation; Nadolol; Portal hypertension; Portosystemic shunt; Propranolol; TIPS; Variceal hemorrhage; Varices

Indexed keywords

2(ACETYLOXY) BENZOIC ACID 3(NITROOXYMETHYL)PHENYL ESTER; ANGIOTENSIN RECEPTOR ANTAGONIST; ANTIBIOTIC AGENT; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CARVEDILOL; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; GLYCERYL TRINITRATE; ISOSORBIDE 5 NITRATE; ISOSORBIDE MONONITRATE; NADOLOL; NCX 1000; NITRATE; OCTREOTIDE; PLACEBO; PRAZOSIN; PROPRANOLOL; SILDENAFIL; SIMVASTATIN; SOMATOSTATIN; TERLIPRESSIN; TIMOLOL; UNCLASSIFIED DRUG; VAPREOTIDE; VASOACTIVE AGENT; VASOCONSTRICTOR AGENT; VASODILATOR AGENT; VASOPRESSIN;

ACUTE VARICEAL HEMORRHAGE; ADVERSE OUTCOME; ASCITES; CREATININE CLEARANCE; DIZZINESS; DOSE RESPONSE; DRUG DOSE COMPARISON; DRUG EFFECT; DRUG EFFICACY; DRUG MECHANISM; DRUG SAFETY; DRUG USE; DRUG WITHDRAWAL; DYSPNEA; ESOPHAGOGASTRODUODENOSCOPY; EVENING DOSAGE; FATIGUE; HUMAN; HYPOTENSION; INTERMETHOD COMPARISON; LOW DRUG DOSE; MORNING DOSAGE; NONHUMAN; RECURRENT DISEASE; REVIEW; SCLEROTHERAPY; SIDE EFFECT; SURGICAL APPROACH; THERAPY EFFECT; TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT; TREATMENT CONTRAINDICATION; UNSPECIFIED SIDE EFFECT; VARICEAL HEMORRHAGE; VARICOSIS; VEIN DISEASE; VEIN LIGATION; VENOUS PRESSURE;

ADRENERGIC BETA-ANTAGONISTS; DRUG THERAPY, COMBINATION; ENDOSCOPY, DIGESTIVE SYSTEM; ESOPHAGEAL AND GASTRIC VARICES; GASTROINTESTINAL HEMORRHAGE; HUMANS; PORTACAVAL SHUNT, SURGICAL; PORTASYSTEMIC SHUNT, TRANSJUGULAR INTRAHEPATIC; RECURRENCE; VASOCONSTRICTOR AGENTS; VASODILATOR AGENTS;

EID: 80052380945     PISSN: 08898553     EISSN: 15581942     Source Type: Journal    
DOI: 10.1016/j.gtc.2011.06.002     Document Type: Review

References (81)

1. Pagliaro L., D'Amico G., Pasta L., et al. Portal hypertension in cirrhosis: natural history. Portal hypertension. Pathophysiology and treatment 1994, 72-92. Blackwell Scientific, Oxford (UK). J. Bosch, R.J. Groszmann (Eds.).
2. Kovalak M., Lake J., Mattek N., et al. Endoscopic screening for varices in cirrhotic patients: data from a national endoscopic database. Gastrointest Endosc 2007, 65:82-88.
3. Garcia-Tsao G., Groszmann R.J., Fisher R.L., et al. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology 1985, 5:419-424.
4. Groszmann R.J., Garcia-Tsao G., Bosch J., et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005, 353:2254-2261.
5. Merli M., Nicolini G., Angeloni S., et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol 2003, 38:266-272.
6. 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, 319:983-989. North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices.
7. Graham D.Y., Smith J.L. The course of patients after variceal hemorrhage. Gastroenterology 1981, 80:800-809.
8. Blei A.T., Garcia-Tsao G., Groszmann R.J., et al. Hemodynamic evaluation of isosorbide dinitrate in alcoholic cirrhosis: pharmacokinetic-hemodynamic interactions. Gastroenterology 1987, 93:576-583.
9. Garcia-Pagan J.C., Villanueva C., Vila M.C., et al. Isosorbide mononitrate in the prevention of first variceal bleed in patients who cannot receive beta-blockers. Gastroenterology 2001, 121:908-914.
10. Gluud L.L., Langholz E., Krag A. Meta-analysis: isosorbide-mononitrate alone or with either beta-blockers or endoscopic therapy for the management of oesophageal varices. Aliment Pharmacol Ther 2010, 32:859-871.
11. Garcia-Tsao G., Grace N., Groszmann R.J., et al. Short term effects of propranolol on portal venous pressure. Hepatology 1986, 6:101-106.
12. Fernandez M., Mejias M., Garcia-Pras E., et al. Reversal of portal hypertension and hyperdynamic splanchnic circulation by combined vascular endothelial growth factor and platelet-derived growth factor blockade in rats. Hepatology 2007, 46:1208-1217.
13. Mejias M., Garcia-Pras E., Tiani C., et al. Beneficial effects of sorafenib on splanchnic, intrahepatic, and portocollateral circulations in portal hypertensive and cirrhotic rats. Hepatology 2009, 49:1245-1256.
14. Storch C.H., Hoeger P.H. Propranolol for infantile haemangiomas: insights into the molecular mechanisms of action. Br J Dermatol 2010, 163:269-274.
15. Lamy S., Lachambre M.P., Lord-Dufour S., et al. Propranolol suppresses angiogenesis in vitro: inhibition of proliferation, migration, and differentiation of endothelial cells. Vascul Pharmacol 2010, 53:200-208.
16. Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: varices and variceal hemorrhage, ascites and spontaneous bacterial peritonitis. Gastroenterology 2001, 120:726-748.
17. Minano C., Garcia-Tsao G. Clinical pharmacology of portal hypertension. Gastroenterol Clin North Am 2010, 39:681-695.
18. D'Amico G., Garcia-Pagan J.C., Luca A., et al. HVPG reduction and prevention of variceal bleeding in cirrhosis. A systematic review. Gastroenterology 2006, 131:1611-1624.
19. Albillos A., Banares R., Gonzalez M., et al. Value of the hepatic venous pressure gradient to monitor drug therapy for portal hypertension: a meta-analysis. Am J Gastroenterol 2007, 102:1116-1126.
20. Garcia-Tsao G., Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med 2010, 362:823-832.
21. de Franchis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010, 53:762-768.
22. Tandon P., Saez R., Berzigotti A., et al. A specialized, nurse-run titration clinic: a feasible option for optimizing beta-blockade in non-clinical trial patients. Am J Gastroenterol 2010, 105:1917-1921.
23. Longacre A.V., Imaeda A., Garcia-Tsao G., et al. A pilot project examining the predicted preferences of patients and physicians in the primary prophylaxis of variceal hemorrhage. Hepatology 2008, 47:169-176.
24. Serste T., Melot C., Francoz C., et al. Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology 2010, 52:1017-1022.
25. Bernard B., Lebrec D., Mathurin P., et al. Beta-adrenergic antagonists in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis. Hepatology 1997, 25:63-70.
26. Senzolo M., Nadal E., Cholongitas E., et al. Is hydrophobia necessary for the hepatologist prescribing nonselective beta-blockers in cirrhosis?. Hepatology 2011, 56:2149-2150.
27. D'Amico G., Pagliaro L., Bosch J. Pharmacological treatment of portal hypertension: an evidence-based approach. Semin Liver Dis 1999, 19:475-505.
28. Bosch J., Abraldes J.G., Berzigotti A., et al. Portal hypertension and gastrointestinal bleeding. Semin Liver Dis 2008, 28:3-25.
29. Gluud L.L., Klingenberg S., Nikolova D., et al. Banding ligation versus beta-blockers as primary prophylaxis in esophageal varices: systematic review of randomized trials. Am J Gastroenterol 2007, 102:2842-2848.
30. Bosch J., Berzigotti A., Garcia-Pagan J.C., et al. The management of portal hypertension: rational basis, available treatments and future options. J Hepatol 2008, 48(Suppl 1):S68-S92.
31. Turnes J., Garcia-Pagan J.C., Abraldes J.G., et al. Pharmacological reduction of portal pressure and long-term risk of first variceal bleeding in patients with cirrhosis. Am J Gastroenterol 2006, 101:506-512.
32. Villanueva C., Aracil C., Colomo A., et al. Acute hemodynamic response to beta-blockers and prediction of long-term outcome in primary prophylaxis of variceal bleeding. Gastroenterology 2009, 137:119-128.
33. 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, 127:476-484.
34. Bosch J., Garcia-Pagan J.C. Prevention of variceal rebleeding. Lancet 2003, 361:952-954.
35. Ripoll C., Tandon P., Garcia-Tsao G. Should the hepatic venous pressure gradient be sequentially measured to monitor beta-blocker therapy in the prophylaxis of variceal hemorrhage?. Controversies in hepatology 2011, 123-131. Slack Incorporated, Thorofare (NJ). D.M. Jensen (Ed.).
36. Garcia-Tsao G., Bosch J. Management of varices in cirrhosis. N Engl J Med 2010, 362:2331-2332.
37. Albillos A., Garcia-Pagan J.C., Iborra J., et al. Propranolol plus prazosin compared with propranolol plus isosorbide-5-mononitrate in the treatment of portal hypertension. Gastroenterology 1998, 115:116-123.
38. Garcia-Pagan J.C., Morillas R., Banares R., et al. Propranolol plus placebo versus propranolol plus isosorbide-5-mononitrate in the prevention of a first variceal bleed: a double-blind RCT. Hepatology 2003, 37:1260-1266.
39. Gournay J., Masliah C., Martin T., et al. Isosorbide mononitrate and propranolol compared with propranolol alone for the prevention of variceal rebleeding. Hepatology 2000, 31:1239-1245.
40. Lo G.H., Chen W.C., Lin C.K., et al. Improved survival in patients receiving medical therapy as compared with banding ligation for the prevention of esophageal variceal rebleeding. Hepatology 2008, 48:580-587.
41. Gonzalez R., Zamora J., Gomez-Camarero J., et al. Meta-analysis: combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis. Ann Intern Med 2008, 149:109-122.
42. Garcia-Tsao G., Sanyal A.J., Grace N.D., et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007, 46:922-938.
43. Levacher S., Letoumelin P., Pateron D., et al. Early administration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients. Lancet 1995, 346:865-868.
44. Escorsell A., Bandi J.C., Andreu V., et al. Desensitization to the effects of intravenous octreotide in cirrhotic patients with portal hypertension. Gastroenterology 2001, 120:161-169.
45. Buonamico P., Sabba C., Garcia-Tsao G., et al. Octreotide blunts post-prandial splanchnic hyperemia in cirrhotic patients: a double-blind randomized echo-Doppler study. Hepatology 1995, 21:134-139.
46. Chen L., Groszmann R.J. Blood in the gastric lumen increases splanchnic blood flow and portal pressure in portal-hypertensive rats. Gastroenterology 1996, 111:1103-1110.
47. D'Amico G., Pietrosi G., Tarantino I., et al. Emergency sclerotherapy versus medical interventions for bleeding oesophageal varices in cirrhotic patients. Cochrane Database Syst Rev 2002, 1. CD002233.
48. Banares R., Albillos A., Rincon D., et al. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology 2002, 35:609-615.
49. Banares R., Moitinho E., Matilla A., et al. Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis. Hepatology 2002, 36:1367-1373.
50. Tripathi D., Ferguson J.W., Kochar N., et al. Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed. Hepatology 2009, 50:825-833.
51. Bosch J., Garcia-Tsao G. Pharmacological versus endoscopic therapy in the prevention of variceal hemorrhage: and the winner is... Hepatology 2009, 50:674-677.
52. Abraldes J.G., Rodriguez-Vilarrupla A., Graupera M., et al. Simvastatin treatment improves liver sinusoidal endothelial dysfunction in CCl4 cirrhotic rats. J Hepatol 2007, 46:1040-1046.
53. Abraldes J.G., Albillos A., Banares R., et al. Simvastatin lowers portal pressure in patients with cirrhosis and portal hypertension: a randomized controlled trial. Gastroenterology 2009, 136:1651-1658.
54. 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, 121:389-395.
55. Tandon P., Abraldes J.G., Berzigotti A., et al. Renin-angiotensin-aldosterone inhibitors in the reduction of portal pressure: a systematic review and meta-analysis. J Hepatol 2010, 53:273-282.
56. Tandon P., Inayat I., Tal M., et al. Sildenafil has no effect on portal pressure but lowers arterial pressure in patients with compensated cirrhosis. Clin Gastroenterol Hepatol 2010, 8:546-549.
57. Berzigotti A., Bellot P., De Gottardi A., et al. NCX-1000, a nitric oxide-releasing derivative of UDCA, does not decrease portal pressure in patients with cirrhosis: results of a randomized, double-blind, dose-escalating study. Am J Gastroenterol 2010, 105:1094-1101.
58. Bernard B., Grange J.D., Khac E.N., et al. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology 1999, 29:1655-1661.
59. Hou M.C., Lin H.C., Liu T.T., et al. Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial. Hepatology 2004, 39:746-753.
60. Laine L., Cook D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis. Ann Intern Med 1995, 123:280-287.
61. de Franchis R., Primignani M. Endoscopic treatment for portal hypertension. Semin Liver Dis 1999, 19:439-455.
62. Singh P., Pooran N., Indaram A., et al. Combined ligation and sclerotherapy versus ligation alone for secondary prophylaxis of esophageal variceal bleeding: a meta-analysis. Am J Gastroenterol 2002, 97:623-629.
63. Khuroo M.S., Khuroo N.S., Farahat K.L., et al. Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding. Aliment Pharmacol Ther 2005, 21:347-361.
64. Garcia-Pagan J.C., Bosch J. Endoscopic band ligation in the treatment of portal hypertension. Nat Clin Pract Gastroenterol Hepatol 2005, 2:526-535.
65. Garcia-Tsao G., Bosch J., Groszmann R.J. Portal hypertension and variceal bleeding-unresolved issues. Summary of an American Association for the Study of Liver Diseases and European Association for the Study of the Liver Single-Topic Conference. Hepatology 2008, 47:1764-1772.
66. Lo G.H., Chen W.C., Wang H.M., et al. Controlled trial of ligation plus nadolol versus nadolol alone for the prevention of first variceal bleeding. Hepatology 2010, 52:230-237.
67. Villanueva C., Piqueras M., Aracil C., et al. A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding. J Hepatol 2006, 45:560-567.
68. 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, 43:167-176.
69. Cheung J., Zeman M., van Zanten S.V., et al. Systematic review: secondary prevention with band ligation, pharmacotherapy or combination therapy after bleeding from oesophageal varices. Aliment Pharmacol Ther 2009, 30:577-588.
70. D'Amico G., Pagliaro L., Bosch J. The treatment of portal hypertension: a meta-analytic review. Hepatology 1995, 22:332-354.
71. Fernandez-Aguilar J.L., Bondia Navarro J.A., Santoyo S.J., et al. Calibrated portacaval H-graft shunt in variceal hemorrhage. Long-term results. Hepatogastroenterology 2003, 50:2000-2004.
72. Bureau C., Garcia-Pagan J.C., Otal P., et al. Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: results of a randomized study. Gastroenterology 2004, 126:469-475.
73. Boyer T.D., Haskal Z.J. The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Hepatology 2005, 41:386-400.
74. Moitinho E., Escorsell A., Bandi J.C., et al. Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology 1999, 117:626-631.
75. Abraldes J.G., Villanueva C., Banares R., et al. Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy. J Hepatol 2008, 48:229-236.
76. Monescillo A., Martinez-Lagares F., Ruiz-del-Arbol L., et al. Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding. Hepatology 2004, 40:793-801.
77. Garcia-Pagan J.C., Caca K., Bureau C., et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010, 362:2370-2379.
78. Luca A., D'Amico G., LaGalla R., et al. TIPS for prevention of recurrent bleeding in patients with cirrhosis: meta-analysis of randomized clinical trials. Radiology 1999, 212:411-421.
79. Khan S., Tudur S.C., Williamson P., et al. Portosystemic shunts versus endoscopic therapy for variceal rebleeding in patients with cirrhosis. Cochrane Database Syst Rev 2006, 4. CD000553.
80. Escorsell A., Banares R., Garcia-Pagan J.C., et al. TIPS versus drug therapy in preventing variceal rebleeding in advanced cirrhosis: a randomized controlled trial. Hepatology 2002, 35:385-392.
81. Henderson J.M., Boyer T.D., Kutner M.H., et al. Distal splenorenal shunt versus transjugular intrahepatic portal systematic shunt for variceal bleeding: a randomized trial. Gastroenterology 2006, 130:1643-1651.