Late complications of liver cirrhosis – management of gastrointestinal bleeding in the presence of portal hypertension
Authors:
Václav Hejda
Authors place of work:
Oddělení gastroenterologie a hepatologie I. interní kliniky LF UK a FN Plzeň
Published in the journal:
Vnitř Lék 2016; 62(Suppl2): 10-17
Category:
Reviews
Jaterní cirhóza je finálním stupněm progresivního vývoje různých jaterních chorob a je spojena s významnou morbiditou a mortalitou. Cirhóza je asociována s řadou potenciálních komplikací, především s rozvojem portální hypertenze. Portální hypertenze s tvorbou ascitu, jaterních a žaludečních varixů s krvácením do horní části trávicího traktu (HČTT) je zlomovým bodem přirozeného vývoje jaterní cirhózy a je spojena s výrazně zhoršenou prognózou pacientů se strmě narůstajícím rizikem jejich mortality. Během posledních 10–20 let bylo dosaženo významné progrese v diagnostice jaterní cirhózy (včetně neinvazivních metod), v primární prevenci první ataky krvácení do HČTT i v terapii akutního krvácení v důsledku moderní farmakoterapie, zlepšených možností terapeutické endoskopie i relativně nových možností zástavy akutního krvácení (jícnové stenty, TIPS apod).
Summary
Cirrhosis is the end stage of progressive development of different liver diseases and is associated with significant morbidity and mortality rates. Cirrhosis is associated with a number of potential complications, in particular with development of portal hypertension. Portal hypertension with the production of ascites, hepatic and gastric varices bleeding in the upper part of the gastrointestinal tract, presents the breakpoint in the natural course of cirrhosis, and it is associated with a considerably worse prognosis of patients, with a dramatically increased risk of mortality. A major progress was reached during the past 10–20 years in diagnosing liver cirrhosis (including non-invasive methods), in primary prevention of the initial episode of upper gastrointestinal bleeding and in the therapy of acute bleeding due to modern pharmacotherapy, with regard to expanding possibilities of therapeutic endoscopy and relatively new options for management of acute bleeding (esophageal stents, TIPS and suchlike). However acute upper gastrointestinal bleeding associated with portal hypertension still presents a considerable risk of premature death (15–20 %). Early diagnosing and causal treatment of numerous liver diseases may lead to slowing or regression of fibrosis and cirrhosis and possibly even of the degree of portal hypertension and thereby also the risk of bleeding.
Key words:
cirrhosis – esophageal varices – treatment of bleeding – portal hypertension
Zdroje
1. Udompap P, Kim D, Kim WR. Current and Future Burden of Chronic Nonmalignant Liver Disease. Clin Gastroenterol Hepatol 2015; 13(12): 2031–2041. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cgh.2015.08.015>.
2. Mokdad AA, Lopez AD, Shahraz S et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med 2014; 12: 145. Dostupné z DOI: <http://dx.doi.org/10.1186/s12916–014–0145-y>.
3. Neff GW, Duncan CW, Schiff ER. The current economic burden of cirrhosis. Gastroenterol Hepatol (NY) 2011; 7(10): 661–671.
4. Wong RJ, Aguilar M, Cheung R et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology 2015; 148(3): 547–555. Dostupné z DOI: <http://dx.doi.org/10.1053/j.gastro.2014.11.039>.
5. Ishak K, Baptista A, Bianchi L et al. Histological grading and staging of chronic hepatitis. J Hepatol 1995; 22(6): 696–699.
6. D‘Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006; 44(1): 217–231.
7. Fleming KM, Aithal GP, Card TR et al. All-cause mortality in people with cirrhosis compared with the general population: a population-based cohort study. Liver Int 2012; 32(1): 79–84. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1478–3231.2011.02517.x>.
8. Albilllos A, Garcia-Tsao G. Classification of cirrhosis: the clinical use of HVPG measurements. Dis Markers 2011; 31(3): 121–128. Dostupné z DOI: <http://dx.doi.org/10.3233/DMA-2011–0834>.
9. Ripoll C, Lastra P, Rincon D et al. Comparison of MELD, HVPG, and their changes to predict clinically relevant endpoints in cirrhosis. Scand J Gastroenterol 2012; 47(2): 204–211. Dostupné z DOI: <http://dx.doi.org/10.3109/00365521.2011.645500>.
10. Ripoll C, Groszmann R, Garcia-Tsao G et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology 2007; 133(2): 481–488.
11. Ripoll C, Banares R, Rincon D et al. Influence of hepatic venous pressure gradient on the prediction of survival of patients with cirrhosis in the MELD Era. Hepatology 2005; 42(4): 793–801.
12. Abraldes JG, Villanueva C, Banares R et al. Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy. J Hepatol 2008; 48(2): 229–236.
13. Albillos A, Banares R, Gonzalez M et al. Value of the heujujkpatic venous pressure gradient to monitor drug therapy for portal hypertension: a meta-analysis. Am J Gastroenterol 2007; 102(5): 1116–1126.
14. Bruno S, Crosignani A, Facciotto C et al. Sustained virologic response prevents the development of esophageal varices in compensated, Child-Pugh class A hepatitis C virus-induced cirrhosis. A 12-year prospective follow-up study. Hepatology 2010; 51(6): 2069–2076. Dostupné z DOI: <http://dx.doi.org/10.1002/hep.23528>.
15. Poynard T, McHutchison J, Manns M et al. Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C. Gastroenterology 2002; 122(5): 1303–1313.
16. Marcellin P, Gane E, Buti M et al. Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study. Lancet 2013; 381(9865): 468–475. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(12)61425–1>
17. Roberts S, Gordon A, McLean C et al. Effect of sustained viral response on hepatic venous pressure gradient in hepatitis C-related cirrhosis. Clin Gastroenterol Hepatol 2007; 5(8): 932–937.
18. Mandorfer M, Kozbial K, Schwabl P et al. Sustained virologic response to interferon-free therapies ameliorates HCV-induced portal hypertension. J Hepatol 2016; pii: S0168–8278(16)30238–0. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jhep.2016.05.027>.
19. Groszmann RJ, Garcia-Tsao G, Bosch J et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005; 353(21): 2254–2261.
20. Merli M, Nicolini G, Angeloni S et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol 2003;38(3):266–272.
21. Garcia-Tsao G, Sanyal AJ, Grace ND et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46(3): 922–938. Erratum in Hepatology 2007; 46(6): 2052.
22. Habib A, Sanyal AJ. Acute variceal hemorrhage. Gastrointest Endosc Clin N Am 2007; 17(2): 223–252, v.
23. Vlachogiannakos J, Goulis J, Patch D et al. Review article: primary prophylaxis for portal hypertensive bleeding in cirrhosis. Aliment Pharmacol Ther 2000; 14(7): 851–860.
24. D‘Amico G, Garcia-Pagan JC, Luca A, Bosch J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology 2006; 131(5): 1611–1624.
25. de Franchis R. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63(3): 743–752. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jhep.2015.05.022>.
26. Colecchia A, Montrone L, Scaioli E et al. Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis. Gastroenterology 2012; 143(3): 646–654. Dostupné z DOI: <http://dx.doi.org/10.1053/j.gastro.2012.05.035>
27. Mori K, Arai H, Abe T et al. Spleen stiffness correlates with the presence of ascites but not esophageal varices in chronic hepatitis C patients. Biomed Res Int 2013; 2013: 857862. Dostupné z DOI: <http://dx.doi.org/10.1155/2013/857862>.
28. Attia D, Schoenemeier B, Rodt T et al. Evaluation of Liver and Spleen Stiffness with Acoustic Radiation Force Impulse Quantification Elastography for Diagnosing Clinically Significant Portal Hypertension. Ultraschall Med 2015; 36(6): 603–610. Dostupné z DOI: <http://dx.doi.org/10.1055/s-0041–107971>.
29. Bosch J. Carvedilol for portal hypertension in patients with cirrhosis. Hepatology 2010; 51(6): 2214–2218. Dostupné z DOI: <http://dx.doi.org/10.1002/hep.23689>.
30. Li L, Yu C, Li Y. Endoscopic band ligation versus pharmacological therapy for variceal bleeding in cirrhosis: a meta-analysis. Can J Gastroenterol 2011; 25(3): 147–155.
31. Hernandez-Gea V, Aracil C, Colomo A et al. Development of ascites in compensated cirrhosis with severe portal hypertension treated with beta-blockers. Am J Gastroenterol 2012; 107(3): 418–427. Dostupné z DOI: <http://dx.doi.org/10.1038/ajg.2011.456>.
32. Senzolo M, Cholongitas E, Burra P et al. beta-Blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis. Liver Int 2009; 29(8): 1189–1193. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1478–3231.2009.02038.x>.
33. Sarin SK, Wadhawan M, Agarwal SR et al. Endoscopic variceal ligation plus propranolol versus endoscopic variceal ligation alone in primary prophylaxis of variceal bleeding. Am J Gastroenterol 2005; 100(4): 797–804.
34. Serste T, Melot C, Francoz C et al. Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology 2010; 52(3): 1017–1022. Dostupné z DOI: <http://dx.doi.org/10.1002/hep.23775>.
35. Mandorfer M, Bota S, Schwabl P et al. Nonselective beta blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. Gastroenterology 2014; 146(7): 1680–1690. Dostupné z DOI: <http://dx.doi.org/10.1053/j.gastro.2014.03.005>.
36. Ruiz-del-Arbol L, Monescillo A, Arocena C et al. Circulatory function and hepatorenal syndrome in cirrhosis. Hepatology 2005; 42(2): 439–447.
37. Burroughs AK, McCormick PA. Prevention of variceal rebleeding. Gastroenterol Clin North Am 1992;21(1):119–147.
38. Jairath V, Rehal S, Logan R et al. Acute variceal haemorrhage in the United Kingdom: patient characteristics, management and outcomes in a nationwide audit. Dig Liver Dis 2014; 46(5): 419–426. Dostupné z DOI: <http://dx.doi.org/10.1016/j.dld.2013.12.010>.
39. Chalasani N, Kahi C, Francois F et al. Improved patient survival after acute variceal bleeding: a multicenter, cohort study. Am J Gastroenterol 2003; 98(3): 653–659.
40. Villanueva C, Colomo A, Bosch A et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013; 368(1): 11–21. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1211801>. Erratum in N Engl J Med. 2013; 368(24): 2341.
41. Wells M, Chande N, Adams P et al. Meta-analysis: vasoactive medications for the management of acute variceal bleeds. Aliment Pharmacol Ther 2012; 35(11): 1267–1278. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1365–2036.2012.05088.x>.
42. Cavallin M, Piano S, Romano A et al. Terlipressin given by continuous intravenous infusion versus intravenous boluses in the treatment of hepatorenal syndrome: A randomized controlled study. Hepatology 2016; 63(3): 983–992. Dostupné z DOI: <http://dx.doi.org/10.1002/hep.283>.
43. Laine L, Cook D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis. Ann Intern Med 1995; 123(4): 280–287.
44. Bosch J, Abraldes JG, Berzigotti A et al. Portal hypertension and gastrointestinal bleeding. Semin Liver Dis 2008; 28(1): 3–25. Dostupné z DOI: <http://dx.doi.org/10.1055/s-2008–1040318>.
45. Paquet KJ, Feussner H. Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices: a prospective controlled randomized trial. Hepatology 1985; 5(4): 580–583.
46. Garcia-Pagan JC, Caca K, Bureau C et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010; 362(25): 2370–2379. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0910102>.
47. Garcia-Pagan JC, Di PM, Caca K et al. Use of early-TIPS for high-risk variceal bleeding: results of a post-RCT surveillance study. J Hepatol 2013; 58(1): 45–50. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jhep.2012.08.020>.
48. Hubmann R, Bodlaj G, Czompo M et al. The use of self-expanding metal stents to treat acute esophageal variceal bleeding. Endoscopy 2006; 38(9): 896–901.
49. McCarty TR, Njei B. Self-expanding metal stents for acute refractory esophageal variceal bleeding: A systematic review and meta-analysis. Dig Endosc 2016; 28(5): 539–547. Dostupné z DOI: <http://dx.doi.org/10.1111/den.12626>
50. Escorsell A, Pavel O, Cardenas A et al. Esophageal balloon tamponade versus esophageal stent in controlling acute refractory variceal bleeding: A multicenter randomized, controlled trial. Hepatology 2016; 63(6): 1957–1967. Dostupné z DOI: <http://dx.doi.org/10.1002/hep.28360>.
51. Henderson JM. Salvage therapies for refractory variceal hemorrhage. Clin Liver Dis 2001; 5(3): 709–725.
52. Ibrahim M, El-Mikkawy A, Mostafa I et al. Endoscopic treatment of acute variceal hemorrhage by using hemostatic powder TC-325: a prospective pilot study. Gastrointest Endosc 2013; 78(5): 769–773. Dostupné z DOI: <http://dx.doi.org/10.1016/j.gie.2013.07.037>.
53. Romero-Castro R, Ellrichmann M, Ortiz-Moyano C et al. EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos). Gastrointest Endosc 2013; 78(5): 711–721. Dostupné z DOI: <http://dx.doi.org/10.1016/j.gie.2013.05.009>.
54. Sarin SK, Jain AK, Jain M et al. A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices. Am J Gastroenterol 2002; 97(4): 1010–1015.
Štítky
Diabetology Endocrinology Gastroenterology and hepatology Internal medicineČlánok vyšiel v časopise
Internal Medicine
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