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Effect of Current Therapies Aimed at Preventing Variceal Rebleeding on Other Complications of Cirrhosis

  • Conference paper
Portal Hypertension VI

Abstract

Nonselective beta blockers (NSBB) and TIPS are used to prevent variceal bleeding. Nevertheless, they may also have an effect on non-bleeding complications or hepatocellular carcinoma. It is well established that patients who have a hemodynamic response to beta blockers have also a lower incidence of other complications of cirrhosis. Beta blockers have also non-hemodynamic effects. Unfortunately, the incidence of non-bleeding complications in the randomized controlled trials evaluating beta blockers in the setting of variceal bleeding prophylaxis has been inconsistently reported, although there seems to be a trend to a lower incidence of hepatocellular carcinoma among patients who receive beta blockers. The beneficial effect of TIPS (which was initially developed with bare stents in the setting of refractory variceal bleeding) on ascites was described early on. The development of covered TIPS with a lower dysfunction rate led to improved control of ascites, without an increase of hepatic encephalopathy. No randomized controlled trials in the context of secondary prophylaxis with covered stents have been performed, outside of the early TIPS setting. In this special population, TIPS led to lower incidence of ascites and ascites-associated complications without an increase of hepatic encephalopathy. Furthermore, patients with early TIPS had better survival. In conclusion, treatments used to prevent rebleeding seem to have a beneficial effect on other complications of cirrhosis. The incidence of other complications of cirrhosis should be described in studies of secondary prophylaxis.

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Author information

Authors and Affiliations

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

    Cristina Ripoll

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

    Salvador Augustin MD

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

    Salvador Augustin MD

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

    Thomas Reiberger

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

    Richard Moreau

  6. UMRS1149, Université Paris Diderot, Paris, France

    Richard Moreau

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

    Richard Moreau

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

    Richard Moreau

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

    Francesco Salerno

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

    Agustin Albillos

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

    Juan G. Abraldes MD, MMSc

  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. Cristina Ripoll
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  2. Salvador Augustin MD
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  3. Thomas Reiberger
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  4. Richard Moreau
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  5. Francesco Salerno
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  6. Agustin Albillos
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  7. Juan G. Abraldes MD, MMSc
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  8. Guadalupe Garcia-Tsao
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Corresponding author

Correspondence to Cristina Ripoll .

Editor information

Editors and Affiliations

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

    Roberto de Franchis

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Ripoll, C. et al. (2016). Effect of Current Therapies Aimed at Preventing Variceal Rebleeding on Other Complications of Cirrhosis. In: de Franchis, R. (eds) Portal Hypertension VI. Springer, Cham. https://doi.org/10.1007/978-3-319-23018-4_33

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  • DOI: https://doi.org/10.1007/978-3-319-23018-4_33

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23017-7

  • Online ISBN: 978-3-319-23018-4

  • eBook Packages: MedicineMedicine (R0)

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