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Preventing the development of varices in cirrhosis.
J Clin Gastroenterol. 2007 Nov-Dec; 41 Suppl 3:S300-4.JC

Abstract

Gastroesophageal varices are a direct consequence of portal hypertension. Nonselective beta-adrenergic blockers decrease portal pressure and are effective in preventing variceal hemorrhage. However, a large multicenter placebo-controlled trial demonstrates that nonselective beta-adrenergic blockers are not effective in preventing the development of varices and are associated with a significant rate of adverse events. This therapy is, therefore, not recommended in compensated cirrhotic patients without varices at large. In this very compensated group of patients with cirrhosis (stage 1, ie, without varices and without ascites or encephalopathy) the predictive value (both for the development of varices and for the development of clinical decompensation) of a baseline hepatic venous pressure gradient greater than 10 mm Hg is confirmed, supporting this threshold level as one that defines a clinically significant portal hypertension. Importantly, reductions in hepatic venous pressure gradient >10% are associated with a significant reduction in the development of varices, a therapeutic goal that could be achieved through the use of beta-blockers or other drugs being developed for the treatment of portal hypertension.

Authors+Show Affiliations

Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA. guadalupe.garcia-tsao@yale.edu

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

17975480

Citation

Garcia-Tsao, Guadalupe. "Preventing the Development of Varices in Cirrhosis." Journal of Clinical Gastroenterology, vol. 41 Suppl 3, 2007, pp. S300-4.
Garcia-Tsao G. Preventing the development of varices in cirrhosis. J Clin Gastroenterol. 2007;41 Suppl 3:S300-4.
Garcia-Tsao, G. (2007). Preventing the development of varices in cirrhosis. Journal of Clinical Gastroenterology, 41 Suppl 3, S300-4.
Garcia-Tsao G. Preventing the Development of Varices in Cirrhosis. J Clin Gastroenterol. 2007 Nov-Dec;41 Suppl 3:S300-4. PubMed PMID: 17975480.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preventing the development of varices in cirrhosis. A1 - Garcia-Tsao,Guadalupe, PY - 2007/12/13/pubmed PY - 2008/2/7/medline PY - 2007/12/13/entrez SP - S300 EP - 4 JF - Journal of clinical gastroenterology JO - J Clin Gastroenterol VL - 41 Suppl 3 N2 - Gastroesophageal varices are a direct consequence of portal hypertension. Nonselective beta-adrenergic blockers decrease portal pressure and are effective in preventing variceal hemorrhage. However, a large multicenter placebo-controlled trial demonstrates that nonselective beta-adrenergic blockers are not effective in preventing the development of varices and are associated with a significant rate of adverse events. This therapy is, therefore, not recommended in compensated cirrhotic patients without varices at large. In this very compensated group of patients with cirrhosis (stage 1, ie, without varices and without ascites or encephalopathy) the predictive value (both for the development of varices and for the development of clinical decompensation) of a baseline hepatic venous pressure gradient greater than 10 mm Hg is confirmed, supporting this threshold level as one that defines a clinically significant portal hypertension. Importantly, reductions in hepatic venous pressure gradient >10% are associated with a significant reduction in the development of varices, a therapeutic goal that could be achieved through the use of beta-blockers or other drugs being developed for the treatment of portal hypertension. SN - 0192-0790 UR - https://www.unboundmedicine.com/medline/citation/17975480/Preventing_the_development_of_varices_in_cirrhosis_ L2 - https://doi.org/10.1097/MCG.0b013e318157c63d DB - PRIME DP - Unbound Medicine ER -