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Secondary Prophylaxis in Special Patient Populations

  • Conference paper
Portal Hypertension VI

  • 1056 Accesses

Abstract

Secondary prophylaxis for variceal bleeding is a cornerstone in the management of in patients with advanced cirrhosis in order to prevent further decompensation. This chapter assessed the current evidence of secondary prophylaxis of variceal bleeding in special populations of cirrhotic patients that also suffer from refractory ascites or HCC or are “clinical” nonresponders to beta-blocker therapy. While patients with HCC receive beta-blocker treatment and endoscopic band ligation less frequently, retrospective data suggest that there is a survival benefit with standard secondary prophylaxis in patients with HCC. Clinical nonresponders to drug therapy (variceal bleeding while on NSBB therapy) have an idiosyncratic higher risk of variceal rebleeding and death even if they receive EBL. This suggests that clinical nonresponders require alternative treatment – such as TIPS. The evidence for efficacy and safety of NSBBs for prophylaxis of variceal (re)bleeding in patients with ascites and refractory ascites is limited. Based on individual data analyses, patients with refractory ascites and (i) arterial hypotension (SAP < 90 mmHg), (ii) increasing serum creatinine, or (iii) and hyponatremia (Na < 130 mmol/L) NSBB therapy should be reduced or discontinued. However, in case of a clear precipitating event (such as SBP), re-initiation of NSBB therapy should be considered given the documented survival benefit with NSBB in secondary prophylaxis.

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Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria

    Thomas Reiberger, Richard Moreau, Cristina Ripoll, Salvador Augustin & Francesco Salerno

  2. Inserm U1149, Centre de Recherche sur l’Inflammation (CRI), Paris, France

    Richard Moreau

  3. UMRS1149, Université Paris Diderot, Paris, France

    Richard Moreau

  4. Département Hospitalo-Universitaire (DHU) UNITY, Service d’Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France

    Richard Moreau

  5. Laboratoire d’Excellence (Labex) Inflamex, ComUE Sorbonne Paris Cité, Paris, France

    Richard Moreau

  6. First Department for Internal Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany

    Cristina Ripoll

  7. Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, University of Alcalá, IRYCIS, CIBERehd, Madrid, Spain

    Agustin Albillos

  8. Liver Unit - Department of Internal Medicine, Hospital Universitari Vall d’Hebron - Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain

    Salvador Augustin

  9. CIBERehd, Juan Rodés Grant Researcher, Instituto de Salud Carlos III, Madrid, Spain

    Salvador Augustin

  10. Internal Medicine and Hepatology, Policlinico IRCCS San Donato, University of Milan, Milan, Italy

    Francesco Salerno

  11. Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Canada

    Juan G. Abraldes

  12. Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA

    Guadalupe Garcia-Tsao

  13. Section of Digestive Diseases, VA-CT Healthcare System, West Haven, Connecticut, USA

    Guadalupe Garcia-Tsao

Authors
  1. Thomas Reiberger
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  2. Richard Moreau
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  3. Cristina Ripoll
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  4. Agustin Albillos
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  5. Salvador Augustin
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  6. Francesco Salerno
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  7. Juan G. Abraldes
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  8. Guadalupe Garcia-Tsao
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Correspondence to Thomas Reiberger .

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  1. Gastroenterology Unit, Luigi Sacco University Hospital, Milan, Italy

    Roberto de Franchis

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Reiberger, T. et al. (2016). Secondary Prophylaxis in Special Patient Populations. In: de Franchis, R. (eds) Portal Hypertension VI. Springer, Cham. https://doi.org/10.1007/978-3-319-23018-4_32

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  • DOI: https://doi.org/10.1007/978-3-319-23018-4_32

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23017-7

  • Online ISBN: 978-3-319-23018-4

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