Comparison of the treatment protocols and etiologic factors in patients with esophageal varicealbleeding

Year 2013, Volume: 12 Issue: 1, 17 - 21, 01.04.2013

Demet Yalçin Kehribar Sibel Demiral Sezer Coşkun Yıldız

Abstract

Background and Aims:Various drugs are used in the medical treatment of esophageal variceal bleeding, which is an important complication of portal hypertension. Today, somatostatin and terlipressin are widely used in the medical treatment of variceal bleeding. The purpose of this study was to evaluate the etiology of esophageal variceal bleeding due to portal hypertension and to compare the efficacy and reliability of somatostatin and terlipressin in the treatment. Materials and Methods:The data of 50 patients, followed prospectively, were evaluated retrospectively. Somatostatin was given to 25 of these patients as treatment following endoscopic band ligation. The other 25 patients were treated with terlipressin. The length of hospital stay, recurrence of bleeding, blood transfusion, and mortality rates were compared between the two groups. Results:Hepatitis B, alcohol, and idiopathic liver cirrhosis were the three primary etiological factors in this study. There were no significant differences in the efficacy of treatment between somatostatin and terlipressin, with cure rates of 56% and 60%, respectively. Terlipressin was more effective than somatostatin in Child A – B patients, but less effective in Child C patients. Conclusions:Somatostatin and terlipressin are quite effective in the primary treatment of esophageal variceal bleeding and can be implemented safely.

Keywords

Esophageal variceal bleeding, portal hypertension, somatostatin, terlipressin

Özofagus varis kanamalı hastalarda etiyolojik sebepler ve tedavi protokollerinin karşılaştırılması

Abstract

Giriş ve Amaç:Portal hipertansiyonun bir komplikasyonu olan özofagus varis kanamasının medikal tedavisinde çeşitli ilaçlar kullanılmıştır. Somatostatin ve terlipressin günümüzde varis kanamasının medikal tedavisinde yaygın olarak kullanılan ilaçlardır. Bu çalışmanın amacı, portal hipertansiyona bağlı özofagus varis kanamalarının etiyolojilerini ve tedavide kullanılan somatostatinin ve terlipressinin etkinliğini ve güvenirliğini karşılaştırmaktır. Gereç ve Yöntem: Prospektif olarak takip edilen 50 hastanın verileri geriye dönük değerlendirildi. Kanama ile başvuran 25 hastaya endoskopik bant tedavisi sonrası somatostatin ve diğer 25 hastaya terlipresin tedavisi verildi. Her iki grubun; hastanede yatış süreleri, tekrar kanama oranları, kan transfüzyonu ve mortalite oranları karşılaştırıldı.Bulgular:Bu çalışmadaki etiyolojik nedenlerde ilk üç sırada hepatit B enfeksiyonu, alkol ve idiyopatik karaciğer sirozu saptandı. Tedavide somatostatin ve terlipressin arasında anlamlı fark bulunmazken, tedavi oranları somatostatinde %56, terlipressinde %60 olarak bulundu. Ayrıca terlipressinin Child A-B'ye giren hastalarda etkinliği somatostatine göre daha yüksek, Child C hastalarda daha düşük saptanmıştır. Sonuç:Somatostatin ve terlipressin özofagus varis kanamasında birincil tedavide oldukça etkindirler ve güvenli bir şekilde uygulanabilirler.

Keywords

Özofagus varis kanaması, portal hipertansiyon, somatostatin, terlipressin

References

• Graham DY, Smith JL. The course of patients after variceal hemor- rhage. Gastroenterology 1981;80:800-9.
• Telatar H, Şimşek H. Portal Hipertansiyon Gastroenteroloji. Telatar H, Şimşek H. (Ed.). Medikomat Basın Yayın ve Ticaret Ltd Şti; An- kara 1993;2:611-29.
• Burrough AK, Planas R, Svoboda P. Optimizing emergency care of upper gastrointestinal bleeding cirrhotic patient. Scand J Gastroen- terol 1998;226:14-24.
• Mishra P, Desai N, Alexander J, et al. Applicability of MELD as a short-term prognostic indicator in patients with liver disease: An indian experience. J Gastroenterol Hepatol 2007;22:1232-5.
• Lebrec D. A discussion of how terlipressin limits mortality in cas- es of bleeding oesophageal varices. Eur J Gastroenterol Hepatol 1998;10:549-52.
• Clinic H. et al. AASLD Chicago 1997; Abstract.
• Escorsell A, Bandi JC, Moitinho E, et al. Time profile of the hae- modynamic effects of terlipressin in portal hypertension. J Hepatol 1997;26:621-7.
• Levacher S, Letoumelin P, Pateron D, et al. Early administration of terlipressin plus glyceryl trinitrate to control active upper gastroin- testinal bleeding in cirrhotic patients. Lancet 1995;346:865-8.
• Groszmann RJ, et al. Drug therapy for portal hypertension: A 5- year rewiew. In: De Franchis R. et al (eds). Portal Hypertension II. Oxfort: Blackwell Science 1996:68-99.
• McK.ee R. A study of octreotide in oesophageal varices. Digestion 1990;45(Suppl 1):60-4.
• Aksöz K, Yazıcıoğlu N, Ünsal B, Gönenç U. Özofagus varis kanamalarında somatostatin tedavisinin etkinliği. Türk J Gastroen- terol 1995;6:256-9.
• Sung JJ, Chung SC, Lai CW, et al. Octreotide infusion or emergency sclerotherapy for variceal haemorrhage. Lancet 1993;342:637-41.
• Prindiville T, Miller M, Trudeau W. Prognostic indicators in acute variceal hemorrhage after treatment by sclerotherapy. Am J Gas- troenterol 1987;82:655-9.
• Vardar R, Karasu Z, Akarca Z, et al. Özofagus varis kanamasında terli- pressin ve somastostatinin etkinlikeri. Ege Tıp Dergisi 2001;40:27-30.
• Walker S, Kreichgauer HP, Bode JC. Terlipressin vs. somatostatin in bleeding esophageal varices: A controlled, double-blind study. Hepatology 1992;15:1023-30.
• Walker S, Kreichgauer HP, Bode JC. Terlipressin (glypressin) versus somatostatin in the treatment of bleeding oesophageal varices- Fi- nal report of a placebo controlled, double-blind study. Z Gastroen- terol 1996;34:692-8.
• Freeman JG, Cobden I, Record CO. Placebo-controlled trial of terli- pressin (glypressin) in the management of acute variceal bleeding. Clin Gastroenterol 1989;11:58-60.
• Söderlund C, Eriksson LS. Medical and surgical treatment of acute bleeding from oesophageal varices in patients with cirrhosis. Scand J Gastroenterol 1991;26:897-908.
• Burroughs A, McCormick P, Hughes MD, et al. Randomized, dou- ble blind, placebo-controlled trial of somatostatin for variceal bleed- ing. Emergency control and prevention of early variceal rebleeding. Gastroenterology 1990;99:1388-95.
• Feu F, Ruiz del Arbol L, Bañares R, et al. Double-blind randomized controlled trial comparing terlipressin and somatostatin for acute variceal hemorrhage. Variceal Bleeding Study Group. Gastroenter- ology 1996;111:1291-9.