“A la carte” treatment of portal hypertension: Adapting medical therapy to hemodynamic response for the prevention of bleeding
✍ Scribed by Christophe Bureau; Jean-Marie Péron; Laurent Alric; Joséphine Morales; Jérǒme Sanchez; Karl Barange; Jean-Louis Payen; Jean-Pierre Vinel
- Publisher
- John Wiley and Sons
- Year
- 2002
- Tongue
- English
- Weight
- 618 KB
- Volume
- 36
- Category
- Article
- ISSN
- 0270-9139
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✦ Synopsis
We report the results of adapting medical therapy to the monitoring of hemodynamic response in the prevention of a first variceal bleeding or rebleeding in patients with cirrhosis. Hepatic venous pressure gradient (HVPG) was measured before and after propranolol was initiated. The patients were considered responders if HVPG decreased below 12 mm Hg or at least 20% as compared with baseline value. If patients were not responders, isosorbide-5 mononitrate (I-5MN) was added, and a third hemodynamic study was performed. Thereafter, the patients were followed for a mean of 28 months. Thirty-four consecutive patients were treated to prevent a first bleeding episode in 20 patients and a rebleeding in 14 patients. he efficacy of medical treatment in portal hypertension to prevent both a first variceal bleed and T rebleeding has been demonstrated by multiple studies and metaanalyses.'J However, some of the patients still experience bleeding while undergoing treatment. Should such a subgroup be identified, the patients could be offered alternative treatment.
It was shown more than 25 years ago that hepatic venous pressure gradient (HVPG) has to be higher than 12 mm Hg for variceal bleeding to occur.-' More recently, Abbrewiations: HWG. hepatic venous pressure gradirnt; I-5MN. isororbide-5 mononitrate.