ACTA FAC MED NAISS 2011;28(2):77-82

Original article

UDC:616.149-008.331.1

Portal Hypertension - Prevention from Variceal Rebleeding

Nenad Joksimović, Vladimir Andreevski, Magdalena Genadieva, Meri Trajkovska

University Clinic of Gastroenterohepatology, Faculty of Medicine in Skopje, Macedonia


SUMMARY

The aim of this study is to present the importance of pharmacologic therapy in an early prevention of bleeding and rebleeding from the oesophageal varices in patients with portal hypertension. Three hundred and fifteen patients with liver cirrhosis have been evaluated and diagnosed in the University Clinic of Gastroenterohepatology. In the evaluation of the degree of the portal hypertension, besides the routine laboratory examination, Colour-Doppler ultrasonography, endoscopy and endosonography have been used. Depending on the results and therapy, all the patients were classified in two main groups: • Patients treated with pharmacologic therapy (propranolol, isosorbid mononitrate and spironolactone) • Control group composed of patients without therapy. Both groups were divided into three subgroups depending of the degree of the oesophageal varices: 1st, 2nd and 3rd degrees. Drug therapy was used as a measure of prevention from bleeding and rebleeding from the dysfunctional varicose-changed blood vessels in the oesophagus. The patients were treated with combined drug therapy with the main effect of decreasing the resistance of the liver circulation and splanhnic flow. We prescribed isosorbide 5 mononitrate, 2 times per day / 20mg, propranolol 2 times / 20mg per day and spironolactone 2 times / 25mg per day in combination in patients with cirrhosis and ascites. From 315 patients with liver cirrhosis and portal hypertension, the A group included 162 (51%) patients. All of them were divided into three groups: with the 1st degree varices reported in 67 patients, 2nd degree in 59 patients and 3rd degree in 36 patients. Rebleeding was not detected in the first degree group. In the 2nd degree group, there were three patients, as well as in the group three with 3rd degree varices. Group B involved 153 patients (49%). First degree varices were reported 69 patients, 2nd in 51 patients, and 3rd degree in 33 patients. Rebleeding was found in two patients with the 1st degree, 2nd degree in 17 patients with and 3rd degree varices in 15 patients. The combination of propranolol, isosorbide 5 mononitrate and spironolactone reduces the portal pressure, which decreases the opportunity of variceal bleeding and rebleeding.

Key words: portal hypertension, liver cirrhosis, endoscopy, endosonography