BACKGROUND AND AIM: Prophylactic treatment of variceal bleeding in cirrhotic patients with beta-blockers is effective in only some patients. Our aim was to determine whether the response of the hepatic venous pressure gradient (HVPG) to the intravenous administration of propranolol predicts the response after chronic oral propranolol treatment. PATIENTS AND METHODS: We included prospectively cirrhotic patients with esophageal varices under primary prophylaxis (PP) and secondary prophylaxis (SP). The HVPG was measured at baseline and after a propranolol bolus (0.15 mg/kg intravenous). A patient was considered a good-responder if HVPG decreased to 12 mmHg or 20% from baseline. Patients then received oral propranolol (heart rate titrated). Poor-responders under SP were also included in a variceal band ligation program. After at least 3 months, a second hemodynamic study was conducted. RESULTS: Fifty-six patients were included (36 SP and 20 PP). Response rate was similar (32.1 and 41.9%, P=0.7) and the Pearson's correlation coefficient was 0.61 (P=0.001). In 81.4% patients, the first study predicted the response status of the second. Six patients rebled on follow-up between the studies, all of them were poor responders to intravenous propranolol. CONCLUSION: A single hemodynamic study using intravenous propranolol seems to predict chronic response to propranolol.
BACKGROUND AND AIM: Prophylactic treatment of variceal bleeding in cirrhoticpatients with beta-blockers is effective in only some patients. Our aim was to determine whether the response of the hepatic venous pressure gradient (HVPG) to the intravenous administration of propranolol predicts the response after chronic oral propranolol treatment. PATIENTS AND METHODS: We included prospectively cirrhoticpatients with esophageal varices under primary prophylaxis (PP) and secondary prophylaxis (SP). The HVPG was measured at baseline and after a propranolol bolus (0.15 mg/kg intravenous). A patient was considered a good-responder if HVPG decreased to 12 mmHg or 20% from baseline. Patients then received oral propranolol (heart rate titrated). Poor-responders under SP were also included in a variceal band ligation program. After at least 3 months, a second hemodynamic study was conducted. RESULTS: Fifty-six patients were included (36 SP and 20 PP). Response rate was similar (32.1 and 41.9%, P=0.7) and the Pearson's correlation coefficient was 0.61 (P=0.001). In 81.4% patients, the first study predicted the response status of the second. Six patients rebled on follow-up between the studies, all of them were poor responders to intravenous propranolol. CONCLUSION: A single hemodynamic study using intravenous propranolol seems to predict chronic response to propranolol.
Authors: Shivaram P Singh; Manav Wadhawan; Subrat K Acharya; Sawan Bopanna; Kaushal Madan; Manoj K Sahoo; Naresh Bhat; Sri P Misra; Ajay Duseja; Amar Mukund; Anil C Anand; Ashish Goel; Bonthala S Satyaprakash; Joy Varghese; Manas K Panigrahi; Manu Tandan; Mihir K Mohapatra; Pankaj Puri; Pravin M Rathi; Rajkumar P Wadhwa; Sunil Taneja; Varghese Thomas; Vikram Bhatia Journal: Indian J Gastroenterol Date: 2021-12-10
Authors: José Ignacio Fortea; Ángela Puente; Patricia Ruiz; Iranzu Ezcurra; Javier Vaquero; Antonio Cuadrado; María Teresa Arias-Loste; Joaquín Cabezas; Susana Llerena; Paula Iruzubieta; Carlos Rodríguez-Lope; Patricia Huelin; Fernando Casafont; Emilio Fábrega; Javier Crespo Journal: World J Clin Cases Date: 2018-11-06 Impact factor: 1.337