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Maintenance of hemodynamic response to treatment for portal hypertension and influence on complications of cirrhosis.
J Hepatol. 2004 May; 40(5):757-65.JH

Abstract

BACKGROUND/AIMS

Following treatment with beta blockers in patients with cirrhosis and portal hypertension, reduction of hepatic venous pressure gradient (HVPG) to <12 mmHg or by >20% of baseline induces an extremely low risk of variceal bleeding. However, several factors such as compliance to therapy or alcohol abstinence may change the initial response after a long follow-up, and the effect of response on other complications of cirrhosis is less clear. The aim of this study was to assess the long-term maintenance of hemodynamic response and its influence on complications of cirrhosis.

METHODS

One hundred and thirty two cirrhotic patients received nadolol and isosorbide mononitrate to prevent variceal rebleeding. HVPG was measured at baseline, after 1 to 3 months under treatment and again 12 to 18 months later.

RESULTS

Sixty four patients were responders. After a longer follow-up, earlier response did not change in 81% of cases. Changes of response were mainly related to modifications in medication dose or in alcohol intake. As compared with poor-responders, responders had a lower probability of developing ascites (P<0.001) and related conditions, a greater improvement of Child-Pugh score (P=0.03), and a lower likelihood of developing encephalopathy (P=0.001) and of requiring liver transplantation (P=0.002). Eleven responders and 22 poor-responders died (P=0.029).

CONCLUSIONS

Hemodynamic response to treatment of portal hypertension is usually sustained after a long-term follow-up. Response decreases the probability of developing complications of cirrhosis and the need for liver transplantation, and significantly improves survival.

Authors+Show Affiliations

Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Avgda. Sant Antoni M? Claret, 167, 08025 Barcelona, Spain. cvillanueva@hsp.santpau.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15094222

Citation

Villanueva, Càndid, et al. "Maintenance of Hemodynamic Response to Treatment for Portal Hypertension and Influence On Complications of Cirrhosis." Journal of Hepatology, vol. 40, no. 5, 2004, pp. 757-65.
Villanueva C, López-Balaguer JM, Aracil C, et al. Maintenance of hemodynamic response to treatment for portal hypertension and influence on complications of cirrhosis. J Hepatol. 2004;40(5):757-65.
Villanueva, C., López-Balaguer, J. M., Aracil, C., Kolle, L., González, B., Miñana, J., Soriano, G., Guarner, C., & Balanzó, J. (2004). Maintenance of hemodynamic response to treatment for portal hypertension and influence on complications of cirrhosis. Journal of Hepatology, 40(5), 757-65.
Villanueva C, et al. Maintenance of Hemodynamic Response to Treatment for Portal Hypertension and Influence On Complications of Cirrhosis. J Hepatol. 2004;40(5):757-65. PubMed PMID: 15094222.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maintenance of hemodynamic response to treatment for portal hypertension and influence on complications of cirrhosis. AU - Villanueva,Càndid, AU - López-Balaguer,Josep M, AU - Aracil,Carles, AU - Kolle,Lilian, AU - González,Begoña, AU - Miñana,Josep, AU - Soriano,German, AU - Guarner,Carlos, AU - Balanzó,Joaquim, PY - 2003/07/11/received PY - 2004/01/16/revised PY - 2004/01/20/accepted PY - 2004/4/20/pubmed PY - 2004/12/16/medline PY - 2004/4/20/entrez SP - 757 EP - 65 JF - Journal of hepatology JO - J Hepatol VL - 40 IS - 5 N2 - BACKGROUND/AIMS: Following treatment with beta blockers in patients with cirrhosis and portal hypertension, reduction of hepatic venous pressure gradient (HVPG) to <12 mmHg or by >20% of baseline induces an extremely low risk of variceal bleeding. However, several factors such as compliance to therapy or alcohol abstinence may change the initial response after a long follow-up, and the effect of response on other complications of cirrhosis is less clear. The aim of this study was to assess the long-term maintenance of hemodynamic response and its influence on complications of cirrhosis. METHODS: One hundred and thirty two cirrhotic patients received nadolol and isosorbide mononitrate to prevent variceal rebleeding. HVPG was measured at baseline, after 1 to 3 months under treatment and again 12 to 18 months later. RESULTS: Sixty four patients were responders. After a longer follow-up, earlier response did not change in 81% of cases. Changes of response were mainly related to modifications in medication dose or in alcohol intake. As compared with poor-responders, responders had a lower probability of developing ascites (P<0.001) and related conditions, a greater improvement of Child-Pugh score (P=0.03), and a lower likelihood of developing encephalopathy (P=0.001) and of requiring liver transplantation (P=0.002). Eleven responders and 22 poor-responders died (P=0.029). CONCLUSIONS: Hemodynamic response to treatment of portal hypertension is usually sustained after a long-term follow-up. Response decreases the probability of developing complications of cirrhosis and the need for liver transplantation, and significantly improves survival. SN - 0168-8278 UR - https://www.unboundmedicine.com/medline/citation/15094222/Maintenance_of_hemodynamic_response_to_treatment_for_portal_hypertension_and_influence_on_complications_of_cirrhosis_ DB - PRIME DP - Unbound Medicine ER -