Band ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis.

BACKGROUND: Portal hypertension commonly accompanies advanced liver disease and often gives rise to life-threatening complications, including haemorrhage from oesophageal and gastrointestinal varices. Variceal haemorrhage commonly occurs in children with chronic liver disease or portal vein obstruction. Prevention is therefore important. Following numerous randomised clinical trials demonstrating efficacy of non-selective beta-blockers and endoscopic variceal ligation in decreasing the incidence of variceal haemorrhage, primary prophylaxis of variceal haemorrhage in adults has become the established standard of care. Hence, band ligation and beta-blockers have been proposed to be used as primary prophylaxis of oesophageal variceal bleeding in children. OBJECTIVES: To determine the benefits and harms of band ligation compared with any type of beta-blocker for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. SEARCH METHODS: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (February 2019), CENTRAL (December 2018), PubMed (December 2018), Embase Ovid (December 2018), LILACS (Bireme; January 2019), and Science Citation Index Expanded (Web of Science; December 2018). We scrutinised the reference lists of the retrieved publications and performed a manual search from the main paediatric gastroenterology and hepatology conferences (NASPGHAN and ESPGHAN) abstract books from 2009 to 2018. We searched ClinicalTrials.gov for ongoing clinical trials. There were no language or document type restrictions. SELECTION CRITERIA: We planned to include randomised clinical trials irrespective of blinding, language, or publication status for assessment of benefits and harms. We planned to also include quasi-randomised and other observational studies retrieved with the searches for randomised clinical trials for report of harm. DATA COLLECTION AND ANALYSIS: We planned to summarise data from randomised clinical trials using standard Cochrane methodologies. MAIN RESULTS: We found no randomised clinical trials assessing band ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. AUTHORS' CONCLUSIONS: Randomised clinical trials assessing the benefits or harms of band ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis are lacking. There is a need for well-designed, adequately powered randomised clinical trials to assess the benefits and harms of band ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. Those randomised clinical trials should include patient-relevant clinical outcomes such as mortality, failure to control bleeding, and adverse events.

Bloqueo beta y alfa adrenérgico con carvedilol en el tratamiento de hipertensos esenciales no complicados: estudio multicéntrico abierto no comparativo / Beta and alfa adrenergic blockade with carvedilol in the treatment of essential hypertensive patients: open, multicenter, non comparative study

Antecedentes: Los beneficios de algunos antihipertensivos están limitados por sus efectos adversos y baja adhesividad a terapia. El Carvedilol es una beta y alfa-bloqueador, sin efectos metabólicos adversos y además, utilizable como monoterapia y muchas veces en monodosis, mejorando adherencia al tratamiento. Objetivos: Evaluar los efectos del Carvedilol, en hipertensos esenciales no complicados sobre presión arterial (PA), glicemia, lípidos, su tolerabilidad, posibilidad de ser usado en monodosis y adherencia a la terapia. Método: Estudio multicéntrico prospectivo, abierto, de 12 semanas. Los resultados fueron sometidos a análisis estadísticos. Se contemplaron normas éticas de investigación clínica. Resultados: 285 enfermos en 79 consultorios, 66 por ciento mujeres, 53,6 ± 12 años de edad. La PA basal mostró que el 28,8 por ciento tenían HT etapa 1; 49,8 por ciento etapa 2 y el 21,4 por ciento etapa 3, clasificación JNC VI, siendo el 90,6 por ciento de los pacientes HT sisto-diastólicos. En promedio la PAS bajó de 159,9 ± 14,8 a 131,3 ± 13.5 mmHg y la PAD de 98,5 ± 8,1 a 80,9 ± 8,6 mmHg. El 4,2 por ciento alcanzó normotensión. El colesterol total bajó de 219,2 a 202,4 mg/100ml (p<0,001). La glicemia no se modificó. El 90,2 por ciento de los pacientes usó 25 mg diarios en dosis única. Los efectos adversos fueron escasos, los más comunes mareos, cefalea, rubor facial, edema e hipotensión. La adhesividad al tratamiento fue de 85,5 por ciento. Como hallazgos secundarios, el 77 por ciento de los hipertensos tenían IMC > 25 kg/m². Conclusiones: Carvedilol mostró buena eficacia antihipertensiva, sin efectos metabólicos adversos y buena tolerabilidad.