Variceal rebleeding frequently develops in patients with cirrhosis after an initial episode of acute variceal hemorrhage. The best prophylactic treatment for variceal rebleeding has not been clearly identified. Several studies have been performed to determine an optimal approach but no agreement exists about how best to treat these patients.
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References
Pagliaro, L. et al. in Portal Hypertension: Pathophysiology and Treatment (eds Bosch, J. & Groszmann, R.J.) 72–92 (Blackwell, Oxford, 1994).
Lebrec, D. & Stiegmann, G. In Portal Hypertension III. Proceedings of the Third Baveno International Consensus Workshop on Definitions, Methodology & Therapeutic Strategy (ed. de Franchis, R.) 170–179 (Blackwell, Oxford, 2001).
D'Amico, G., Pagliaro, L. & Bosch, J. Pharmacological treatment of portal hypertension: an evidence-based approach. Semin. Liver Dis. 19, 475–505 (1999).
Gournay, J., Masliha, C., Martin, T., Perrin, D. & Galmiche, J. P. Isosorbide mononitrate and propanolol compared with propranolol alone for the prevention of variceal rebleeding. Hepatology 31, 1239–1245 (2000).
de Franchis, R. Updating consensus in portal hypertension: report of the Baveno III consensus workshop on definitions, methodology and therapeutic strategies in portal hypertension. J. Hepatol. 33, 846–852 (2000).
Laine, L., el Newihi, H. M., Migikovsky, B., Sloane, R. & Garcia, F. Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices. Ann. Intern. Med. 119, 1–7 (1993).
Lo, G. et al. Endoscopic variceal ligation plus nadolol and sucralfate compared with ligation alone for the prevention of variceal rebleeding: a prospective, randomized trial. Hepatology 32, 461–465 (2000).
de la Peña, J. et al. Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: a multicenter trial. Hepatology 41, 572–578 (2005).
Gonzales, R. et al. Meta-analysis: combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis. Ann. Intern. Med. 149, 109–122 (2008).
Garcia-Pagan, J. C. et al. Nadolol plus isosorbide mononitrate alone or associated with band ligation in the prevention of variceal rebleeding: a multicentre randomized controlled trial. Gut 58, 1144–1150 (2009).
Kumar, A. et al. Addition of propranolol and isosorbide mononitrate to endoscopic variceal ligation does not reduce variceal rebleeding incidence. Gastroenterology 137, 892–901 (2009).
Burroughs, A. K. et al. In Portal Hypertension IV. Proceedings of the Fourth Baveno International Consensus Workshop on Definitions, Methodology & Therapeutic Strategy (ed. de Franchis, R.) 11–39 (Wiley-Blackwell, Oxford, 2006).
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Kravetz, D. Secondary prophylaxis for variceal bleeding. Nat Rev Gastroenterol Hepatol 7, 10–11 (2010). https://doi.org/10.1038/nrgastro.2009.216
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DOI: https://doi.org/10.1038/nrgastro.2009.216