Subject(s)
Male , Female , Humans , Adult , Young Adult , Middle Aged , Aged , Esophageal and Gastric Varices/therapy , Gastrointestinal Hemorrhage/therapy , Ligation , Proton Pump Inhibitors/therapeutic use , Vasoconstrictor Agents/therapeutic use , Combined Modality Therapy , Proton Pump Inhibitors/adverse effects , Reproducibility of Results , Vasoconstrictor Agents/adverse effectsABSTRACT
One of the most relevant complications of portal hypertension in cirrhosis is the development of gastroesophageal varices. They are present in 50 percent of patients with cirrhosis at the diagnosis. The risk of bleeding depends on the degree of portal hypertension and the severity of liver disease. Variceal hemorrhage is the most common lethal complication of cirrhosis. In the last decades there had been numerous clinical trials involving different treatment options for variceal bleeding (pharmacological, endoscopic and surgery) trying to establish the best treatment strategy. Since the rise in portal pressure is the cause of variceal rupture, therapies that can decrease portal pressure have a theoretical rationale for their use. Endoscopic treatment, although effective, has no effect on portal pressure. Vasoactive agents (vasopressin and its analogue terlipressin, somatostatin and its analogue octreotide) cause splanchnic vasoconstriction and decrease portal pressure. Pharmacological treatments have the advantage that they can be easily administered, and started as soon as the diagnosis of variceal bleeding is suspected. This makes pharmacological treatment especially attractive for centers that have no chance of emergency endoscopy. At this moment there is sufficient evidence to recommend combined treatment with vasoactive drugs and endoscopy for the control of variceal hemorrhage.
Una de las principales complicaciones de los pacientes cirróticos con hipertensión portal es el desarrollo de várices gastroesofágicas. Éstas están presentes al momento del diagnóstico en alrededor de 50 por ciento de los pacientes con cirrosis. La hemorragia variceal es la complicación letal más frecuente en los pacientes cirróticos. En las últimas décadas se han realizado múltiples esfuerzos para lograr definir la mejor combinación de técnicas (endoscópicas, farmacológicas y quirúrgicas) para disminuir la morbimortalidad asociada a la hemorragia variceal. Dado que la causa de la ruptura de las várices es un aumento de la presión portal, todas las medidas que logren disminuirla son medidas racionales para lograr detener la hemorragia. El tratamiento endoscópico, si bien efectivo, no afecta la fisiopatología de la hemorragia variceal. Las drogas vasoconstrictoras (vasopresina y su derivado terlipresina o somatostatina y su derivado octreotide) actúan a nivel de la circulación esplácnica, disminuyendo el flujo sanguíneo. El tratamiento farmacológico tiene la ventaja de ser fácilmente administrado, incluso antes de realizar una endoscopia, toda vez que se sospecha una hemorragia variceal, lo que hace particularmente atractivo su uso en centros en que no se cuenta con endoscopia de urgencia. Actualmente, existe suficiente evidencia para recomendar el uso de estos fármacos como terapia adicional a la endoscopia ante la sospecha de una hemorragia variceal.
Subject(s)
Humans , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/drug therapy , Esophageal and Gastric Varices/complications , Vasoconstrictor Agents/therapeutic use , Hypertension, Portal/complications , Lypressin/analogs & derivatives , Lypressin/therapeutic use , Patient Selection , Vasopressins/therapeutic useABSTRACT
Osteoporosis is a common complication after liver transplantation. Aim: To assess bone mineral density of patients prior to liver transplantation. Material and Methods: Retrospective review of medical records of patients with liver cirrhosis, subjected to liver transplantation that had a measurement of bone mineral density prior to the operation. Results: Twenty nine of 112 transplanted patients complied with the inclusion criteria. Their mean age was 55 +/- 11 years, their body mass index was 26.9 +/- 3.2 k/m2, 73 percent were males and the period of clinical evolution prior to transplantation lasted 3.7 +/-2.9 years. Twenty four percent had an alcoholic liver disease, 21 percent C hepatitis and 14 percent non-alcoholic steatohepatitis. The main risk factors for osteoporosis were medication intake in 79 percent, alcohol in 52 percent, smoking in 41 percent and concomitant diseases in 31 percent. Bone mineral density was normal in 31 percent and showed osteopenia and osteoporosis in 48 and 21 percent of patients, respectively. Patients with a normal mineral density were younger than the rest of patients (46.9 +/- 13.4 and 58.5 +/- 7.4 years respectively p < 0.01). Conclusions: Patients subjected to liver transplantation had a high frequency of osteoporosis or osteopenia prior to the surgical procedure.