New Evidence of Therapy for Variceal Haemorrahage in Cirrhosis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Yiping

Department of Gastroenterolgy; West China Hospital of Sichuan University; Chengdu 610041; China;

Corresponding author：

Keywords：

Variceal Haemorrahage in Cirrhosis; Evidence-based therapy

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Variceal bleeding in cirrhosis is one of the most challenging problems in gastroenterology. Bleeding from gastro-oesophageal varices is a main cause of early death (approximately 30%-50% at the first bleeding) in cirrhosis. The aim of our therapy is to locate the place of bleeding, control active bleeding and prevent rebleeding, but it is difficult sometimes. A number of treatment strategies, such as somatostain analogs, vasopressin, endoscopic therapy, transjugular intrahepatic portasystemic shunt (TIPS) have evolved over time, but which is better? New evidence of therapy for variceal haemorrhage will be introduced in Cirrhosis that includes: 1.Somatostatin, vasopressin, ligation, schlerotherapy and balloon tamponade for acute variceal bleeding; 2.β-blockers, ligation, schlerotherapy and shunt surgery for prophylaxis of primary variceal bleeding; 3.β-blockers, ligation, schlerotherapy, shunt surgery and TIPS for prophylaxis of variceal rebleeding; 4. Antibiotic prophylaxis for cirrhosis with gastrointestinal bleeding.

Citation： WANG Yiping. New Evidence of Therapy for Variceal Haemorrahage in Cirrhosis. Chinese Journal of Evidence-Based Medicine, 2004, 04(3): 205-209. doi: Copy

1.	［1］DeDombal FT, Clarke JR, Clamp SE, Malizia G, Kotwal MR, Morgan AG. Prognostic factors in upper GI bleeding[J]. Endoscopy, 1986; 18 ( Suppl 2 ) :6-10.
2.	［2］Bornman PC , Ktige JEJ , Terbhnche J . Management of oesophageal varices[J]. Lancet, 1994 ;343:1 079-1 084.
3.	［3］MeDonald J , Burroughs A , Feagan B . Evidence based Gastroenterologiy and heapatology[J]. BM J, 1999; 389-425.
4.	［4］Juan G. Abraldes, Jaime Bosch. Somatostatin and analogues in portal hypertension[J]. Hepatology, 2002; 35(6) :1 305.
5.	［5］Gotzsche PC, Gjomp I, Bonnen H, Somatostatin V. placebo in bleeding esophageal varices: randomised trail and meta-analysis[J]. BMJ, 1995; 310: 1 495-1498.
6.	［6］Burroughs AK, International Octerotide varices Study group.Double blind Rct of 5 day octreotide versus placebo associated with sclerotherapy for trail failures (abstract) [J]. Hepatology,1996; 24: 352A.
7.	［7］Ioannou G , Doust J , Rockey DC . Terlipressin for acute esophageal variceal hemorrhage ( Cochrane Review) [J ]. In:The Cochrane Library, Issue 1, 2003. Oxford: Update Software. Date of most recent substantive amendment: 30 October 2002.
8.	［8］Imperiale T F, Teran J C, McCullough A J. A meta-analysis of somatostatin versus vasopressin in the management of acute esophageal variceal hemorrhage [ J ]. Gastroenterology, 1995;109(4): 1 289-1 294.
9.	［9］Hartigan PM, Gebhard RL, Gregory PB, For the veterans Cooperative Variceal Slerotherapy Group. Scleroterapy for actively bleeding esophageal varices in man alcoholics with cirrhosis[J]. Gastrointest Endosc, 1997; 46:1-7.
10.	［10］D’Amico G, Pietrosi G, Tarantino I, Pagliaro L. Emergency sclerotherapy versus medical interventions for bleeding oesophageal varices in cirrhotic patients ( Cochrane Review) [ J ]. In:The Cochrane Library, Issue 1, 2003. Oxford: Update Software. Date of most recent amendment: 28 November 2001.
11.	［11］Laine L , Cook D . Endoscopic ligation compared with schlerotherapy for treatment of esophageal variceal bleeding: a meta-analysis[J]. Annals of Internal Medicine, 1995. 123(4). 280-287.
12.	［12］Heresbach D, Jacquelinet C, Noud O, Chaperon J, Bretagne J F, Gosselin M. Sclerotherapie venus ligature au cours de 1hemonagie par rupture de varices oesophagiennes: meta-analyse directe des essais randomises. ( Sclerotherapy versus banding hgation for bleeding esophageal varices: meta-analysis of randomized clinical trials) [J ]. Gastroenterologie Clinique et Biologique,1995. 19( 11 ). 914-920.
13.	［13］Gross M, Schiemann U, Muhlhofer A, Zoller W G. Meta-analysis: eflicacy of therapeutic regimens inongoing variceal bleeding[J]. Endoscopy, 2001. 33 (9). 737-746.
14.	［14］Banares R, Albillos A, Rincon D, Alonso S, Gonzalez M,Ruiz-del-Arbol L, Salcedo M, Molinero LM. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: A meta-analysis [J]. Hepatology,2002. 35(3). 609-615.
15.	［15］BoyerTD , pharmacologic treatment of Portal hypertension:Past, Present, and future [ J ]. Hepatology, 2002; 34 ( 4 ):834-839.
16.	［16］Fardy J M , Laupacis A . A meta - analysis ofprophylactic endoscopic sderotherapy for esophageal varices [J]. American Journal of Gastroenterology, 1994. 89 ( 11 ). 1 938-1 948.
17.	［17］Imperiale T F, Chalasani N. A rneta-analysis of endoscopic variceal hgation for primary prophylaxis of esophageal variceal bleeding[J]. Hepatology, 2001. 33(4). 802-807.
18.	［18］Bernard B, Lebrec D, Mathurin P, Opolon P, Poynard T.Beta-adrenergic antagonists in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis [J ]. Heparology, 1997. 25(1). 63-70.
19.	［19］Bernard B, Lebrec D, Mathurin P, Opolon P, Poynard T.Propranolol and sclerotherapy in the prevention of gastrointestinal Rebleeding in patients with cirrhosis: a meta-analysis[J].Journal of Hepatology, 1997; 26(2). 312-324.
20.	［20］Singh P, Pooran N, Indaram A, Bank S. Combined ligarion and sclerotherapy versus ligation alone for secondary prophylaxis of esophageal variceal bleeding: a meta-analysis [ J ]. American Journal of Gastroenterology, 2002. 97 (3). 623-629.
21.	［21］Luca A, D’Amico G, La Galla R, Midiri M, Morabito A,Pagliaro L. TIPS for prevention of recurrent bleeding in patients with cirrhosis: meta-analysis of randomized clinical trials[J]. Radiology, 1999. 212(2). 411-421.
22.	［22］Papatheodoridis G V, Goulis J, Leandro G, Patch D, Burroughs A K. Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding: a meta-analysis[J]. Hepatology, 1999. 30(3). 612-622.
23.	［23］Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L. Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding[J]. In: The Coehrune Library, Issue 1,2003. Oxford: Update Software) Date of most recent substantive amendment:24 January 2002.

1. ［1］DeDombal FT, Clarke JR, Clamp SE, Malizia G, Kotwal MR, Morgan AG. Prognostic factors in upper GI bleeding[J]. Endoscopy, 1986; 18 ( Suppl 2 ) :6-10.
2. ［2］Bornman PC , Ktige JEJ , Terbhnche J . Management of oesophageal varices[J]. Lancet, 1994 ;343:1 079-1 084.
3. ［3］MeDonald J , Burroughs A , Feagan B . Evidence based Gastroenterologiy and heapatology[J]. BM J, 1999; 389-425.
4. ［4］Juan G. Abraldes, Jaime Bosch. Somatostatin and analogues in portal hypertension[J]. Hepatology, 2002; 35(6) :1 305.
5. ［5］Gotzsche PC, Gjomp I, Bonnen H, Somatostatin V. placebo in bleeding esophageal varices: randomised trail and meta-analysis[J]. BMJ, 1995; 310: 1 495-1498.
6. ［6］Burroughs AK, International Octerotide varices Study group.Double blind Rct of 5 day octreotide versus placebo associated with sclerotherapy for trail failures (abstract) [J]. Hepatology,1996; 24: 352A.
7. ［7］Ioannou G , Doust J , Rockey DC . Terlipressin for acute esophageal variceal hemorrhage ( Cochrane Review) [J ]. In:The Cochrane Library, Issue 1, 2003. Oxford: Update Software. Date of most recent substantive amendment: 30 October 2002.
8. ［8］Imperiale T F, Teran J C, McCullough A J. A meta-analysis of somatostatin versus vasopressin in the management of acute esophageal variceal hemorrhage [ J ]. Gastroenterology, 1995;109(4): 1 289-1 294.
9. ［9］Hartigan PM, Gebhard RL, Gregory PB, For the veterans Cooperative Variceal Slerotherapy Group. Scleroterapy for actively bleeding esophageal varices in man alcoholics with cirrhosis[J]. Gastrointest Endosc, 1997; 46:1-7.
10. ［10］D’Amico G, Pietrosi G, Tarantino I, Pagliaro L. Emergency sclerotherapy versus medical interventions for bleeding oesophageal varices in cirrhotic patients ( Cochrane Review) [ J ]. In:The Cochrane Library, Issue 1, 2003. Oxford: Update Software. Date of most recent amendment: 28 November 2001.
11. ［11］Laine L , Cook D . Endoscopic ligation compared with schlerotherapy for treatment of esophageal variceal bleeding: a meta-analysis[J]. Annals of Internal Medicine, 1995. 123(4). 280-287.
12. ［12］Heresbach D, Jacquelinet C, Noud O, Chaperon J, Bretagne J F, Gosselin M. Sclerotherapie venus ligature au cours de 1hemonagie par rupture de varices oesophagiennes: meta-analyse directe des essais randomises. ( Sclerotherapy versus banding hgation for bleeding esophageal varices: meta-analysis of randomized clinical trials) [J ]. Gastroenterologie Clinique et Biologique,1995. 19( 11 ). 914-920.
13. ［13］Gross M, Schiemann U, Muhlhofer A, Zoller W G. Meta-analysis: eflicacy of therapeutic regimens inongoing variceal bleeding[J]. Endoscopy, 2001. 33 (9). 737-746.
14. ［14］Banares R, Albillos A, Rincon D, Alonso S, Gonzalez M,Ruiz-del-Arbol L, Salcedo M, Molinero LM. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: A meta-analysis [J]. Hepatology,2002. 35(3). 609-615.
15. ［15］BoyerTD , pharmacologic treatment of Portal hypertension:Past, Present, and future [ J ]. Hepatology, 2002; 34 ( 4 ):834-839.
16. ［16］Fardy J M , Laupacis A . A meta - analysis ofprophylactic endoscopic sderotherapy for esophageal varices [J]. American Journal of Gastroenterology, 1994. 89 ( 11 ). 1 938-1 948.
17. ［17］Imperiale T F, Chalasani N. A rneta-analysis of endoscopic variceal hgation for primary prophylaxis of esophageal variceal bleeding[J]. Hepatology, 2001. 33(4). 802-807.
18. ［18］Bernard B, Lebrec D, Mathurin P, Opolon P, Poynard T.Beta-adrenergic antagonists in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis [J ]. Heparology, 1997. 25(1). 63-70.
19. ［19］Bernard B, Lebrec D, Mathurin P, Opolon P, Poynard T.Propranolol and sclerotherapy in the prevention of gastrointestinal Rebleeding in patients with cirrhosis: a meta-analysis[J].Journal of Hepatology, 1997; 26(2). 312-324.
20. ［20］Singh P, Pooran N, Indaram A, Bank S. Combined ligarion and sclerotherapy versus ligation alone for secondary prophylaxis of esophageal variceal bleeding: a meta-analysis [ J ]. American Journal of Gastroenterology, 2002. 97 (3). 623-629.
21. ［21］Luca A, D’Amico G, La Galla R, Midiri M, Morabito A,Pagliaro L. TIPS for prevention of recurrent bleeding in patients with cirrhosis: meta-analysis of randomized clinical trials[J]. Radiology, 1999. 212(2). 411-421.
22. ［22］Papatheodoridis G V, Goulis J, Leandro G, Patch D, Burroughs A K. Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding: a meta-analysis[J]. Hepatology, 1999. 30(3). 612-622.
23. ［23］Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L. Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding[J]. In: The Coehrune Library, Issue 1,2003. Oxford: Update Software) Date of most recent substantive amendment:24 January 2002.

Chinese Journal of Evidence-Based Medicine

New Evidence of Therapy for Variceal Haemorrahage in Cirrhosis

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