Effects of postoperative use of proton pump inhibitors on gastrointestinal bleeding after endoscopic variceal treatment during hospitalization

BACKGROUND Endoscopic variceal treatment(EVT)is recommended as the mainstay choice for the management of high-risk gastroesophageal varices and acute variceal bleeding in liver cirrhosis.Proton pump inhibitors(PPIs)are widely used for various gastric acid-related diseases.However,the effects of PPIs on the development of post-EVT complications,especially gastrointestinal bleeding(GIB),remain controversial.AIM To evaluate the effects of postoperative use of PPIs on post-EVT complications in patients with liver cirrhosis during hospitalization.METHODS Patients with a diagnosis of liver cirrhosis who were admitted to the Department of Gastroenterology of the General Hospital of Northern Theater Command,treated by an attending physician between January 2016 and June 2020 and underwent EVT during their hospitalization were included.Logistic regression analyses were performed to explore the effects of postoperative use of PPIs on the development of post-EVT complications during hospitalization.Odds ratios(ORs)with 95%confidence intervals(CIs)were calculated.RESULTS A total of 143 patients were included.The incidence of post-EVT GIB and other post-EVT complications was 4.90%and 46.85%,respectively.In the overall analyses,postoperative use of PPIs did not significantly reduce the risk of post-EVT GIB(OR=0.525,95%CI=0.113-2.438,P=0.411)or other post-EVT complications(OR=0.804,95%CI=0.413-1.565,P=0.522).In the subgroup analyses according to the enrollment period,type and route of PPIs after the index EVT,use of PPIs before the index EVT,use of vasoactive drugs after the index EVT,indication of EVT(prophylactic and therapeutic),and presence of portal venous system thrombosis,ascites,and hepatocellular carcinoma,the effects of postoperative use of PPIs on the risk of post-EVT GIB or other post-EVT complications remain not statistically significant.CONCLUSION Routine use of PPIs after EVT should not be recommended in patients with liver cirrhosis for the prevention of post-EVT complications during hospitalization.

Nonselective beta-blockers in cirrhotic patients with no or small varices:A meta-analysis

AIM:To explore effects of nonselective beta-blockers(NSBBs) in cirrhotic patients with no or small varices.METHODS:The Pub Med,EMBASE,Science Direct,and Cochrane library databases were searched for relevant papers.A meta-analysis was performed using ORs with 95%CI as the effect sizes.Subgroup analysis was conducted according to the studies including patients without varices and those with small varices.RESULTS:Overall,784 papers were initially retrieved from the database searches,of which six randomized controlled trials were included in the meta-analysis.The incidences of large varices development(OR = 1.05,95%CI:0.25-4.36;P = 0.95),first upper gastrointestinal bleeding(OR = 0.59,95%CI:0.24-1.47;P = 0.26),and death(OR = 0.70,95%CI:0.45-1.10;P = 0.12) were similar between NSBB and placebo groups.However,the incidence of adverse events was significantly higher in the NSBB group compared with the placebo group(OR = 3.47,95%CI:1.45-8.33;P = 0.005).The results of subgroup analyses were similar to those of overall analyses.CONCLUSION:The results of this meta-analysis indicate that NSBBs should not be recommended for cirrhotic patients with no or small varices.

Correlation analysis of collagen proportionate area in Budd-Chiari syndrome: A preliminary clinicopathological study

BACKGROUND Collagen proportionate area(CPA) is an important index for assessing the severity of liver fibrosis. Budd-Chiari syndrome can frequently progress to liver fibrosis and cirrhosis. CPA might play an important role in the pathological progress of Budd-Chiari syndrome.AIM To explore the role of CPA in predicting the outcomes of patients with BuddChiari syndrome.METHODS Nine patients with Budd-Chiari syndrome undergoing transjugular intrahepatic portosystemic shunt(TIPS) were included. The median CPA level and correlation of CPA and prognosis of TIPS were determined.RESULTS Median CPA was 23.07%(range: 0%-40.20%). Pearson's χ2 test demonstrated a significant correlation of CPA with history of gastrointestinal bleeding(Pearson's coefficient: 0.832, P = 0.005), alanine aminotransferase(Pearson's coefficient:-0.694, P = 0.038), and prothrombin time(Pearson's coefficient: 0.68, P = 0.044).Although CPA was not significantly correlated with shunt dysfunction or hepatic encephalopathy after TIPS, the absolute CPA was relatively larger in patients who developed shunt dysfunction or hepatic encephalopathy after TIPS.CONCLUSION This preliminary clinicopathological study found a marginal effect of CPA on the outcomes of Budd-Chiari syndrome patients treated with TIPS.

传统止血和凝血试验与肝硬化急性上消化道出血的关系:一项回顾性研究

目的:回顾性比较伴与不伴急性上消化道出血(AUGIB)或急性食管静脉曲张出血(AEVB)的肝硬化患者止血/凝血指标的差异,包括血小板计数(PLT)、凝血酶原时间(PT)、国际标准化比率(INR)和活化部分凝血活酶时间(APTT)。方法:2012年1月至2014年6月间,共计1734例肝硬化患者纳入研究。根据其病史分为AUGIB组(497例)和无AUGIB组(1237例);同时根据内镜检查结果分为AEVB组(297例)和无AEVB组(1259例),另178例AUGIB患者由于缺乏内镜资料,既未入AEVB组,也未归入无AEVB组。结果:AUGIB组与无AUGIB组患者相比,PLT(99.99±89.90 vs 101.47±83.03,P=0.734)和APTT(42.96±15.20 vs 43.77±11.01,P=0.219)的差异无统计学意义,但PT显著延长(17.30±5.62 vs 16.03±4.68,P<0.001),INR显著增高(1.45±0.69 vs 1.31±0.59,P<0.001)。PT可以独立预测AUGIB的发生,PT越低,AUGIB出现的可能性越小(OR=0.968,95%CI:0.942-0.994)。AEVB组与无AEVB组患者相比,PLT显著减少(86.87±62.14 vs 101.74±83.62,P=0.004),APTT显著缩短(40.98±7.98 vs 43.72±10.97,P<0.001),但PT(16.53±3.71 vs 16.0464.68,P=0.088)和INR(1.35±0.41 vs 1.3160.59,P=0.225)的差异则无统计学意义。PLT可独立预测AEVB的发生,PLT越高,AEVB出现的可能性越大(OR=1.004,95%CI:1.002-1.006)。结论:PLT与肝硬化患者门脉高压出血密切相关。

对肝硬化静脉曲张非侵入性诊断试验的认识:对辽宁省医学会消化病分会的问卷调查

背景和目的:由于上消化道内镜具有侵入性,对于肝硬化静脉曲张的非侵入性诊断试验已经在许多研究中广泛应用。我们向辽宁省医学会消化病分会的委员发放调查问卷,了解其对肝硬化静脉曲张非侵入性诊断试验的认识。方法:向辽宁省医学会第9届消化病分会全体42名委员发放调查问卷,了解其对肝硬化静脉曲张非侵入性诊断试验的认识。这42名委员来自13座城市的33家医院。结果:97.6%(41/42)的调查对象完成了问卷调查,其中大多为主任医生(85.4%),从事消化疾病医疗工作超过20年(80.5%),就职于三级医院(97.6%)。46.3%的调查对象所在科室,每年接诊肝硬化胃食管静脉曲张病例超过200例。90.2%的调查对象所在科室,常规使用上消化道内镜来诊断胃食管静脉曲张。只有6名(15%)调查对象会在临床中经常采用非侵入性诊断试验。30名(75%)调查对象知道至少一项静脉曲张的非侵入性诊断试验。对非侵入性诊断试验认识的多少与其所在医院肝硬化静脉曲张的病例数(P=0.038)和是否应用上消化道内镜来诊断静脉曲张(P=0.022)有关。结论:本次问卷调查结果显示,肝硬化患者静脉曲张的非侵入性诊断试验在中国辽宁省甚少应用于临床实践。有必要通过进一步的多中心观察研究来找到可靠的非侵入性诊断指标。