A Noninferiority Trial Comparing 2 Days vs 5 Days of Terlipressin and Ceftriaxone in Terms of 5-Day Rebleeding for Patients With Acute Gastroesophageal Variceal Hemorrhage DOI
Gin‐Ho Lo,

Jen-Hao Yeh,

Cheng‐Hao Tseng

et al.

The American Journal of Gastroenterology, Journal Year: 2024, Volume and Issue: 119(9), P. 1821 - 1830

Published: March 25, 2024

INTRODUCTION: This trial was to shorten the duration of both vasoconstrictors and prophylactic antibiotics only 2 days in therapy acute gastroesophageal variceal hemorrhage. METHODS: After successful endoscopic hemostasis hemorrhage, eligible patients were randomized receive terlipressin infusion 1 mg per 6 hours ceftriaxone g daily for 5 (group A) or a similar regimen B). Primary end points very early rebleeding at days, secondary included 48-hour hemostasis, 42-day rebleeding, hospitalization days. RESULTS: Group A comprised 48 patients, group B 52 patients. Both groups comparable severity liver disease. Forty-eight-hour initial 95.8% 100% ( P = 0.13). Very between 3 occurred patient (2.1%) (3.8%) 0.60). The difference 1.8% 95% confidence interval −1.31% 2.08%, which demonstrated noninferiority. Forty-two-day (10.4%) 4 (7.7%) 0.63). median 8.5 ± 3.8 vs 5.6 2.6 < 0.001). DISCUSSION: bleeding, combination 2-day not inferior 5-day terms with advantage shortening stay.

Language: Английский

Gut-liver axis: Pathophysiological concepts and medical perspective in chronic liver diseases DOI Creative Commons
Susana Rodrigues, Van der Merwe, Aleksander Krag

et al.

Seminars in Immunology, Journal Year: 2024, Volume and Issue: 71, P. 101859 - 101859

Published: Jan. 21, 2024

Language: Английский

Citations

19
AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review DOI Open Access
Guadalupe García–Tsao, Juan G. Abraldeṣ, Nicole E. Rich

et al.

Gastroenterology, Journal Year: 2023, Volume and Issue: 166(1), P. 202 - 210

Published: Nov. 18, 2023

Language: Английский

Citations

28
Diagnosis and Management of Esophagogastric Varices DOI Creative Commons

Socrate Pallio,

G Melita, Endrit Shahini

et al.

Diagnostics, Journal Year: 2023, Volume and Issue: 13(6), P. 1031 - 1031

Published: March 8, 2023

Acute variceal bleeding (AVB) is a potentially fatal complication of clinically significant portal hypertension and one the most common causes acute upper gastrointestinal bleeding. Thus, esophagogastric varices represent major economic population health issue. Patients with advanced chronic liver disease typically undergo an endoscopy to screen for varices. However, not recommended patients stiffness < 20 KPa platelet count > 150 × 109/L as there low probability high-risk should receive primary prophylaxis either nonselective beta-blockers or endoscopic band ligation. In cases AVB, within 12 h after resuscitation hemodynamic stability, whereas be performed soon possible if are unstable. suspected bleeding, starting vasoactive therapy in combination treatment recommended. On other hand, uncontrolled balloon tamponade self-expandable metal stents can used bridge more definitive such transjugular intrahepatic portosystemic shunt. This article aims offer comprehensive review recommendations from international guidelines well recent updates on management

Language: Английский

Citations

25
Diagnostic accuracy of magnetically guided capsule endoscopy with a detachable string for detecting oesophagogastric varices in adults with cirrhosis: prospective multicentre study DOI Creative Commons
Xi Jiang, Jun Pan,

Qing Xu

et al.

BMJ, Journal Year: 2024, Volume and Issue: unknown, P. e078581 - e078581

Published: March 5, 2024

Abstract Objective To evaluate the diagnostic accuracy and safety of using magnetically guided capsule endoscopy with a detachable string (ds-MCE) for detecting grading oesophagogastric varices in adults cirrhosis. Design Prospective multicentre study. Setting 14 medical centres China. Participants 607 (>18 years) cirrhosis recruited between 7 January 2021 25 August 2022. underwent ds-MCE (index test), followed by oesophagogastroduodenoscopy (OGD, reference test) within 48 hours. The participants were divided into development validation cohorts ratio 2:1. Main outcome measures primary outcomes sensitivity specificity compared OGD. Secondary included high risk oesophageal varices, gastric varices. Results OGD examinations completed 582 (95.9%) participants. Using as standard, had 97.5% (95% confidence interval 95.5% to 98.7%) 97.8% (94.4% 99.1%) (both P<0.001 prespecified 85% threshold). When optimal 18% threshold luminal circumference oesophagus derived from cohort (n=393), (n=189) 95.8% (89.7% 98.4%) 94.7% (88.2% 97.7%), respectively. was 96.3% (92.6% 98.2%), 96.9% (95.2% 98.0%), 96.7% (95.0% 97.9%), Two serious adverse events occurred but none ds-MCE. Conclusion findings this study suggest that is highly accurate safe tool promising alternative screening surveillance patients Trial registration ClinicalTrials.gov NCT03748563 .

Language: Английский

Citations

9
CT-based nomogram predicts esophageal gastric variceal bleeding in noncirrhotic portal hypertension caused by hepatic schistosomiasis DOI Creative Commons

Wei Cheng,

Ke-Ying Wang,

Wenqiang Li

et al.

BMC Medical Informatics and Decision Making, Journal Year: 2025, Volume and Issue: 25(1)

Published: Jan. 7, 2025

To construct a nomogram combining CT varices vein evaluation and clinical laboratory tests for predicting the risk of esophageal gastric variceal bleeding (EGVB) in patients with noncirrhotic portal hypertension (NCPH). A total 315 NCPH non-EGVB EGVB were retrospectively enrolled randomly divided into training testing cohorts. Thirteen collateral vessels identified evaluated after system reconstruction. Multivariate binary logistic regression analysis was used to choose images predictors EGVB. The score each patient calculated. built by selected receiver operating characteristic (ROC) curve evaluate predictive performance nomogram. Platelet count prothrombin time as predictors; vein, gastroepiploic omental image reduced platelet count, prolonged time, severe tortuosity less patients. specificity, sensitivity, negative value, positive value AUC ROC 0.82, 0.81, 0.89, 0.70, 0.88 (95% CI: 0.84–0.93) cohort 0.87, 0.86, 0.88, 0.84, 0.91 0.84–0.97) cohort, respectively. could be useful individualize predict Results showed that CT-evaluated (varices score) realize personalized prediction first-time

Language: Английский

Citations

1
Predicting mortality in geriatric patients with peptic ulcer bleeding: a retrospective comparative study of four scoring systems DOI Creative Commons
Ömerul Faruk Aydın, Ali Cankut Tatlıparmak

PeerJ, Journal Year: 2025, Volume and Issue: 13, P. e19090 - e19090

Published: March 17, 2025

Peptic ulcer bleeding (PUB) is a significant cause of morbidity and mortality, especially in geriatric patients. Risk stratification tools such as AIMS65, Glasgow Blatchford Score (GBS), T-score, Age, Blood tests, Comorbidities (ABC) score are frequently used to predict outcomes PUB This study aims compare the predictive performance these four scoring systems patients with PUB. retrospective cohort included aged 65 years older who were diagnosed between January 1, 2019, 2024, tertiary care hospital. Data collected demographic information, clinical presentation, laboratory results, comorbidities. GBS, T-Score, ABC calculated for each patient. The primary outcome was in-hospital mortality. A total 315 study, an overall mortality rate 7.9%. AIMS65 had highest area under curve (area receiver operating characteristic (AUROC): 0.829), followed by (AUROC: 0.775). GBS 0.694) T-score 0.526) demonstrated lower performance. Pairwise comparisons showed statistically difference (p = 0.0214). most accurate predictor more effective predicting compared T-Score. Implementing practice could improve risk decision-making processes managing high-risk elderly

Language: Английский

Citations

1
Clinical Trial: A Multicentre Randomised Controlled Trial of Carvedilol Versus Variceal Band Ligation in Primary Prevention of Variceal Bleeding in Liver Cirrhosis (CALIBRE Trial) DOI Creative Commons
Dhiraj Tripathi, Kelly Handley, Lisa Holden

et al.

Alimentary Pharmacology & Therapeutics, Journal Year: 2025, Volume and Issue: unknown

Published: April 16, 2025

ABSTRACT Background The superior efficacy of non‐selective beta‐blockers (NSBB) compared with variceal band ligation (VBL) in the primary prevention bleeding is uncertain. Aim To compare carvedilol versus VBL for bleeding. Methods CALIBRE was an investigator‐initiated, multicentre, randomised, controlled, open‐label trial. Participants were randomly assigned to 12.5 mg once daily or VBL. Inclusion criteria cirrhosis and medium large oesophageal varices that had not bled. outcome any within 1 year randomisation. Secondary outcomes include survival, other complications cirrhosis, quality life, cost‐effectiveness adverse events. Recruitment closed early, mainly due impact pandemic. Results 265 participants (10% intended sample size) from 52 sites randomised ( n = 133) 132) between 22 January 2019 31 August 2022. 5/133 (3.8%) arm vs. 10/132 (7.6%) experienced (risk ratio 0.50 (95% confidence interval [CI]; 0.17–1.41); risk difference − 0.038 CI; −0.094—0.017)). Serious events occurred one participant each treatment arm, no treatment‐related deaths. Of secondary outcomes, there statistically significant differences. Carvedilol cheaper resulted slightly more quality‐adjusted life years than Conclusions early terminated and, thus, underpowered trial showed c arvedilol patients medium‐to large‐sized varices. No untoward safety concerns noted. Trial Registration ISRCTN73887615

Language: Английский

Citations

1
Optimizing antithrombotic therapy in patients with coexisting cardiovascular and gastrointestinal disease DOI
Azita H. Talasaz, Parham Sadeghipour, Luis Ortega‐Paz

et al.

Nature Reviews Cardiology, Journal Year: 2024, Volume and Issue: 21(8), P. 574 - 592

Published: March 20, 2024

Language: Английский

Citations

6
Endoscopic procedures in hepatology: Current trends and new developments DOI Open Access
Wim Laleman, Emma Vanderschueren, Zain Mehdi

et al.

Journal of Hepatology, Journal Year: 2023, Volume and Issue: 80(1), P. 124 - 139

Published: Sept. 18, 2023

Language: Английский

Citations

15
Clinical Guideline on Perioperative Management of Patients with Advanced Chronic Liver Disease DOI Creative Commons
Lidia Canillas,

Amalia Pelegrina,

Juan G. Álvarez

et al.

Life, Journal Year: 2023, Volume and Issue: 13(1), P. 132 - 132

Published: Jan. 3, 2023

(1) Background: Patients with advanced chronic liver disease (ACLD) are living longer more comorbidities because of improved medical and surgical management. However, patients ACLD at increased risk perioperative morbidity mortality; (2) Methods: We conducted a comprehensive review the literature to support narrative clinical guideline about assessment mortality management in undergoing procedures; (3) Results: Slight data exist guide ACLD, most recommendations based on case series expert opinion. The severity dysfunction, portal hypertension, cardiopulmonary renal comorbidities, complexity surgery type (elective versus emergent) predictors mortality. Expert multidisciplinary teams necessary evaluate manage before, during, after (4) Conclusions: This practice document updates available optimize who undergo procedures.

Language: Английский

Citations

14