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1.
Medicine (Baltimore) ; 99(5): e18923, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000404

RESUMO

To evaluate the risk of first upper gastrointestinal bleeding by computerized tomoscanning (CT) for esophageal varices patients with cirrhotic portal hypertension.One hundred thirty two esophageal varices patients with cirrhotic portal hypertension who are also complicated with gastrointestinal bleeding were recruited as bleeding group, while another 132 patients without bleeding as non-bleeding group. The diameter of esophageal varices, number of vascular sections, and total area of blood vessels were measured by CT scanning. The sensitivity and specificity of these indicators were calculated, and Youden index was adjusted with the critical point.The diameter of esophageal varices was 7.83 ±â€Š2.76 mm in bleeding group, and 6.57 ±â€Š3.42 mm in non-bleeding group. The Youden index was 0.32 with the critical point 5.55 mm. The area under the receiver operating characteristics (AUROC) was 0.72. The number of venous vessels was 4.5 ±â€Š2 in bleeding group, whereas being 4 ±â€Š2 in non-bleeding group. The Youden index was 0.35 with a critical point 4, and the area under the curve (AUC) was 0.68. The blood vessel area was 1.73 ±â€Š1.15 cm in bleeding group, and 1.12 ±â€Š0.89 cm in non-bleeding group. The Youden index was 0.48 with the critical point being 1.03 cm, and corresponding AUC was 0.82.Among all 3 indicators of the total area, diameter, and number of sections of the esophageal varices, the total area of esophageal varices showed more accuracy as a potential and novel indicator for bleeding prediction.


Assuntos
Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Hemorragia Gastrointestinal/diagnóstico por imagem , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Tomografia Computadorizada por Raios X , Adulto , Idoso , Varizes Esofágicas e Gástricas/epidemiologia , Esôfago/diagnóstico por imagem , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/epidemiologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Sensibilidade e Especificidade
2.
Rev Med Suisse ; 16(681): 331-333, 2020 Feb 12.
Artigo em Francês | MEDLINE | ID: mdl-32049457

RESUMO

Pancreatic arteriovenous malformations are rare conditions, mostly asymptomatic and increasingly diagnosed incidentally. Once symptomatic, patients can present with non specific abdominal pain, potentially life-threatening gastrointestinal bleeding, acute pancreatitis or portal hypertension. The aim of this article is to present the pathophysiology underlying this type of vascular malformation, to discuss its diagnostic modalities and the therapeutic options described to date in the literature.


Assuntos
Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/terapia , Pâncreas/patologia , Pâncreas/fisiopatologia , Doença Aguda , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/patologia , Hemorragia Gastrointestinal/complicações , Humanos , Hipertensão Portal/complicações , Pancreatite/complicações
3.
Wien Klin Wochenschr ; 132(1-2): 1-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31912289

RESUMO

BACKGROUND AND AIMS: Portal hypertensive gastropathy (PHG) is common in patients with cirrhosis and may cause bleeding. This study systematically explored the independent impact of patient characteristics, portal hypertension and hepatic dysfunction on PHG severity and associated anemia. METHODS: Patients with cirrhosis undergoing endoscopy were included in this retrospective analysis and PHG was endoscopically graded as absent, mild or severe. Clinical and laboratory parameters and hepatic venous pressure gradient (HVPG) were assessed with respect to an association with severity of PHG. RESULTS: A total of 110 patients (mean age: 57 years, 69% male) with mostly alcoholic liver disease (49%) or viral hepatitis (30%) were included: 15 (13.6%) patients had no PHG, 59 (53.6%) had mild PHG, and 36 (32.7%) had severe PHG. Severe PHG was significantly associated with male sex (83.3% vs. 62.2% in no or mild PHG; p = 0.024) and higher Child-Turcotte-Pugh (CTP) stage (CTP-C: 38.9% vs. 27.0% in no or mild PHG; p = 0.030), while MELD was similar (p = 0.253). Patients with severe PHG had significantly lower hemoglobin values (11.2 ± 0.4 g/dL vs. 12.4 ± 0.2 g/dL; p = 0.008) and a higher prevalence of iron-deficiency anemia (IDA: 48.5% vs. 26.9%; p = 0.032). Interestingly, HVPG was not significantly higher in severe PHG (median 20 mm Hg) vs. mild PHG (19 mm Hg) and no PHG (18 mm Hg; p = 0.252). On multivariate analysis, CTP score (odds ratio, OR: 1.25, 95% confidence interval, CI 1.02-1.53; p = 0.033) was independently associated with severe PHG, while only a trend towards an independent association with IDA was observed (OR: 2.28, 95% CI 0.91-5.72; p = 0.078). CONCLUSION: The CTP score but not HVPG or MELD were risk factors for severe PHG. Importantly, anemia and especially IDA are significantly more common in patients with severe PHG.


Assuntos
Anemia Ferropriva , Varizes Esofágicas e Gástricas , Hipertensão Portal , Gastropatias , Anemia Ferropriva/complicações , Varizes Esofágicas e Gástricas/complicações , Feminino , Hemorragia Gastrointestinal , Humanos , Hipertensão Portal/complicações , Cirrose Hepática , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Gastropatias/complicações
4.
Am J Forensic Med Pathol ; 41(1): 75-77, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31714290

RESUMO

Ruptured esophageal varices can present as sudden death from gastrointestinal hemorrhage. The most common underlying pathology causing esophageal varices is cirrhosis leading to portal hypertension. However, not all esophageal varices arise from portal hypertension, and not all portal hypertensions are caused by cirrhosis. We present a rare case of ruptured esophageal varices casing death in an individual with metastatic tumor (high-grade) neuroendocrine tumor in the liver causing portal hypertension. This is, to the best of our knowledge, the first case report in the literature reporting a neuroendocrine tumor causing esophageal varices. This case report aims to document this rather rare entity, highlight another mechanism on how metastatic disease can result in sudden death, and give a brief review of literature on metastatic tumor in the liver causing esophageal varices.


Assuntos
Varizes Esofágicas e Gástricas/patologia , Hemorragia Gastrointestinal/patologia , Hipertensão Portal/complicações , Neoplasias Hepáticas/patologia , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/etiologia , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/patologia , Ruptura Espontânea/etiologia , Ruptura Espontânea/patologia
5.
Medicine (Baltimore) ; 98(47): e17961, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764798

RESUMO

To assess the utility of spleen stiffness as a diagnostic tool in individuals with human immunodeficiency virus (HIV) and non-cirrhotic portal hypertension (NCPH).The Philips EPIQ7, a new point shearwave elastography (pSWE) technique, was used to assess liver and spleen stiffness in 3 patient groups. Group 1: HIV and NCPH (n = 11); Group 2: HIV with past didanosine (ddI) exposure without known liver disease or NCPH (n = 5); Group 3: HIV without known liver disease or ddI exposure (n = 9).Groups were matched for age, HIV chronicity, and antiretroviral treatment (including cumulative ddI exposure in Groups 1 and 2). Differences in liver and spleen stiffness (in kPa) between groups were analyzed using the Mann-Whiney U test.Liver and spleen stiffness were both significantly higher in NCPH versus ddI-exposed (P = .019 and P = .006) and ddI-unexposed controls (P = .038 and P < .001). Spleen stiffness was more effective than liver stiffness at predicting NCPH, area under receiver operating characteristic (AUROC) 0.812 versus 0.948. Combining the 2 variables improved the diagnostic performance, AUROC 0.961. The optimal cut-off for predicting NCPH using splenic stiffness was 25.4 kPa, with sensitivity 91%, specificity 93%, positive predictive value (PPV) 91%, negative predictive value (NPV) 93%, positive likelihood ratio 12.73, negative likelihood ratio 0.10. Spleen and liver stiffness scores were strongly correlated (P = .0004, 95% confidence interval [CI] 18, 59).Elevated spleen stiffness is observed in HIV with NCPH and can be quantified easily using pSWE with high diagnostic accuracy. Novel strategies such as pSWE for longitudinal monitoring of patients with HIV and NCPH should be considered.


Assuntos
Técnicas de Imagem por Elasticidade , Hipertensão Portal/diagnóstico por imagem , Baço/diagnóstico por imagem , Estudos Transversais , Feminino , Infecções por HIV/complicações , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Baço/fisiopatologia
6.
Niger J Clin Pract ; 22(11): 1617-1620, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31719286

RESUMO

Budd-Chiari syndrome (BCS) is a rare disease characterized by obstruction of hepatic venous outflow tract with diversified etiologies. Sea-blue histiocytosis (SBH) is a kind of storage diseases defined by the deposition of abundant sea-blue histiocytes in various organs and can lead to hepatosplenomegaly, cirrhosis, or even liver failure. The association between BCS and SBH has never been reported before. Here, we report a patient with BCS presenting with hepatosplenomegaly, portal hypertension, and pancytopenia who was later confirmed to also have SBH.


Assuntos
Síndrome de Budd-Chiari/complicações , Hepatomegalia/diagnóstico por imagem , Hipertensão Portal/complicações , Pancitopenia/complicações , Síndrome do Histiócito Azul-Marinho/diagnóstico , Esplenomegalia/diagnóstico por imagem , Adulto , Síndrome de Budd-Chiari/diagnóstico , Síndrome de Budd-Chiari/etiologia , Hepatomegalia/complicações , Humanos , Masculino , Doenças Raras , Esplenomegalia/complicações , Veia Cava Inferior
7.
Zhonghua Gan Zang Bing Za Zhi ; 27(9): 673-676, 2019 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-31594090

RESUMO

Objective: To investigate the incidence of hepatic encephalopathy (HE) in patients with non-cirrhotic portal hypertension (NCPH) and to explore its risk factors. Methods: The incidence rate of HE in 150 cases with NCPH was evaluated in two hospitals, and 188 cases of compensated cirrhosis patients were taken as control. Logistic regression was used to screen for independent risk factors for HE in patients with NCPH. Results: The incidence of overt hepatic encephalopathy (OHE) in patients with NCPH was not statistically significantly different from that in patients with cirrhosis (4.7% vs. 6.9%, P = 0.682). The incidence of mild hepatic encephalopathy (MHE) was significantly lower than that of cirrhosis patients (32.7% vs. 46.3%, P < 0.05). The presence of upper gastrointestinal bleeding, infection and portosystemic venous shunt were the main independent factors for HE in NCPH patients (OR > 1, P < 0.05). Conclusion: HE is one of the important complications of NCP, and may be influenced by factors such as upper gastrointestinal bleeding, infection and portosystemic venous shunt.


Assuntos
Encefalopatia Hepática/complicações , Hipertensão Portal/complicações , Hemorragia Gastrointestinal/complicações , Humanos , Cirrose Hepática , Derivação Portossistêmica Cirúrgica , Fatores de Risco
9.
Georgian Med News ; (292-293): 26-32, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31560658

RESUMO

Cirrhotic cardiomyopathy (CC) is a frequent complication of liver cirrhosis (LC) and characterised by impaired contractile response to stress, altered diastolic relaxation, and QTc prolongation. Symptoms of CC can be masked by edematous ascitic syndrome, high cardiac output, hyperdynamic circulation and preserved left ventricular (LV) ejection fraction at rest. NT-proBNP is a sensitive marker of heart failure in patients with primary heart disease, but its diagnostic value in CC has not been determined. The aim of the study was to evaluate NT-proBNP levels in patients with LC and estimate its relationship with the severity of the main disease, cardiac and hemodynamic dysfunction. The study involved 90 patients with LC (age 49,9±1,92 years). LC decompensation was associated with an increase of end-systolic, end-diastolic volume (ESV, EDV), left ventricular myocardial index (LVMI), cardiac index (CI), decrease E/A and preserve ejection fraction (EF) at rest. Serum NT-proBNP levels in class A, B and C were 109±26.2, 174±17.6, 358±40.1 pg/ml (p˂0.05). The highest NT-proBNP levels were in patients with refractory ascites, severe esophagus varices, hepatorenal syndrome, hypoalbuminemia (374±49.4, 345±33.9, 467±47.4, 323±32.0 pg/ml), the lowest - in pre-ascitics patients (112±23.4 pg/ml). NT-proBNP was correlated with CTP, MELD, serum albumin, portal vein diameter (r= 0.550, 0.429, -0.334, 0.237, p˂0.05), eGFR, CI, EDV, LVMI, E/A (r= 0.419, 0.401, 0.296, 0.233, 0.325, p˂0.05). Thus, elevated levels of NT-proBNP may be an indicator of cardiac dysfunction in patients with LC.


Assuntos
Cardiopatias/complicações , Hipertensão Portal/complicações , Cirrose Hepática/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Biomarcadores/sangue , Humanos , Cirrose Hepática/complicações
10.
Z Gastroenterol ; 57(8): 983-996, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31398770

RESUMO

Portal hypertension in patients with liver cirrhosis can be improved, not only by surgical or interventional shunt placements, but also by drug-only treatment. Many recent studies addressed the question whether any of these substances can improve survival of patients with liver cirrhosis when administered continuously for months and years. Non-selective beta-blockers (NSBB), statins, antibiotics, enoxaparin and albumin have been shown to possess many beneficial effects in the pathophysiology of portal hypertension or on events leading to decompensation of liver cirrhosis. Accordingly, they represent candidate drugs for long-term treatment to improve patient survival. In contrast to NSBB, antibiotics and albumin, which have clearly defined indications in the treatment of complications related to portal hypertension, the role of statins and anticoagulants in the management of these patients remains to be further elucidated. Recent studies came to opposing results when a permanent treatment was tested to improve patient prognosis or to prevent liver decompensation. At present, there is no reason to change our everyday practice beyond established management proposals published in practice guidelines. This paper gives an overview of present and future indications for treatment with NSBB, antibiotics, statins, anticoagulants and albumin with special reference to studies aiming at improving prognosis of patients with liver cirrhosis.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Hipertensão Portal/complicações , Cirrose Hepática/tratamento farmacológico , Anticoagulantes/administração & dosagem , Humanos , Prognóstico
11.
Med Sci Monit ; 25: 5969-5976, 2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31400275

RESUMO

BACKGROUND This study aimed to assess the prevalence, clinical characteristics, and risk factors for sinistral portal hypertension in patients with moderate or severe acute pancreatitis. MATERIAL AND METHODS A retrospective study included 825 patients with moderate or severe acute pancreatitis. Clinical and demographic data, the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Ranson scores for severity of acute pancreatitis, and the computed tomography (CT) severity index (CTSI) were evaluated. The formation of collateral vessels, bleeding, splenomegaly, hypersplenism during hospitalization or follow-up, and early anticoagulation and the occurrence of sinistral portal hypertension were evaluated. RESULTS Of the 825 patients with moderate or severe acute pancreatitis, 103 patients (12.5%) developed sinistral portal hypertension. The median time to diagnosis was 8 months, and the median patient age was 39 years. The most common causes of pancreatitis were biliary (46.3%), hypertriglyceridemia (31.5%), alcohol (14.9%), and others (7.3%). Independent risk factors for sinistral portal hypertension were male gender (OR, 4.666; 95% CI, 2.54-8.572; P<0.001), recurrent acute pancreatitis (OR, 9.556; 95% CI, 5.218-17.5; P<0.001), hypertriglyceridemia (OR, 2.056; 95% CI, 1.184-3.57; P=0.001), glucose >10 mmol/L (OR, 6.965; 95% CI, 4.027-12.045; P<0.001), smoking (OR, 6.32; 95% CI, 3.544-11.269; P<0.001), and infection of walled-off necrosis (OR=1.637; 95% CI, 1.061-2.524; P=0.015). Anticoagulation during hospitalization was not significantly associated with sinistral portal hypertension. CONCLUSIONS Hypertriglyceridemia, hyperglycemia, infection of walled-off necrosis, recurrent acute pancreatitis, and smoking were risk factors for sinistral portal hypertension, and early anticoagulation did not prevent the occurrence.


Assuntos
Hipertensão Portal/complicações , Hipertensão Portal/etiologia , Pancreatite/complicações , APACHE , Doença Aguda , Adulto , Feminino , Humanos , Hipertensão Portal/metabolismo , Hipertrigliceridemia/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
12.
J Korean Med Sci ; 34(33): e223, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31436052

RESUMO

BACKGROUND: This study aimed to determine the prognostic role of the categorized hemodynamic stage (HS) based on the hepatic venous pressure gradient (HVPG) in patients with portal hypertension. METHODS: Of 1,025 cirrhotic patients who underwent HVPG measurement, data on 572 non-critically-ill patients were collected retrospectively between 2008 and 2013. The following two HS categorizations were used: HS-1 (6-9, 10-12, 13-16, 17-20, and > 20 mmHg; designated as groups 1-5, respectively) and HS-2 (6-12, 13-20, and > 20 mmHg). Clinical characteristics, mortality rates, and prognostic predictors were analyzed according to the categorized HS. RESULTS: During the mean follow-up period of 25 months, 86 (15.0%) patients died. The numbers of deaths in HS-1 groups were 7 (6.3%), 7 (6.9%), 30 (18.0%), 20 (15.6%), and 22 (34.4%), respectively (P < 0.001). However, the traditional HVPG cutoffs of 10 and 16 mmHg did not improve the discrimination of mortality. In contrast, the mortality rates did differ significantly between the three HS-2 groups (P < 0.05). In the multivariate analysis, all models revealed that HS-2 was a common prognostic factor in predicting mortality. The mortality rates increased significantly according to HS-2 in patients with hypoalbuminemia (HVPG, 13-20 mmHg; hazard ratio [HR], 2.54 and HVPG > 20 mmHg; HR, 5.45) and intermediate model for end-stage liver disease (MELD) score (HVPG, 13-20 mmHg; HR, 3.86 and HVPG > 20 mmHg; HR, 8.77; P < 0.05). CONCLUSION: Categorizing HVPG values according to HS-2 is a useful prognostic modality in patients with portal hypertension and can play an independent role in predicting the prognosis in patients with hypoalbuminemia and an intermediate MELD score.


Assuntos
Veias Hepáticas/fisiopatologia , Hipertensão Portal/diagnóstico , Cirrose Hepática/mortalidade , Adulto , Idoso , Feminino , Hemodinâmica , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/patologia , Hipoalbuminemia/diagnóstico , Cirrose Hepática/complicações , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Risco , Índice de Gravidade de Doença , Taxa de Sobrevida
13.
Am J Case Rep ; 20: 948-952, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31266933

RESUMO

BACKGROUND Management of patients with ectopic variceal bleeding can be challenging and requires a multidisciplinary approach. Ectopic bleeding from jejunal varices at the anastomotic site of choledochojejunostomy is rare and difficult to treat. CASE REPORT We report a case of ectopic jejunal variceal bleeding secondary to portal vein stenosis at the anastomotic site of a prior choledochojejunostomy for pancreatic cancer. The patient was successfully treated with portal vein metallic stent placement that remained patent for 7 months. CONCLUSIONS The management of ectopic of variceal bleeding remains difficult and controversial. Portal vein stenting has been reported as a successful method of treatment that is minimally invasive especially in patients who had prior major surgeries.


Assuntos
Jejuno/irrigação sanguínea , Jejuno/cirurgia , Veia Porta/cirurgia , Stents , Varizes/cirurgia , Idoso , Coledocostomia , Constrição Patológica/complicações , Constrição Patológica/cirurgia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/cirurgia , Cuidados Paliativos , Resultado do Tratamento
14.
Surgery ; 166(5): 907-913, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31285046

RESUMO

BACKGROUND: Portal diversion by surgical shunt plays a major role in the treatment of medically refractory portal hypertension. We evaluate our center's experience with surgical shunts for the treatment of pediatric portal hypertension. METHODS: All patients who underwent surgical shunt at a single institution from 2008 to 2017 were reviewed. The primary outcome was intervention-free shunt patency. RESULTS: In this study, 34 pediatric patients underwent portal shunt creation. The median age was 7.7 years (interquartile range 4.3-12.0). Twenty-nine patients (85%) had prehepatic portal hypertension and 5 patients (15%) had intrahepatic portal hypertension. The primary manifestations of portal hypertension were esophageal varices (97%) and gastrointestinal bleeding (77%). Eighteen patients (53%) underwent meso-Rex bypass, 10 patients (29%) underwent splenorenal shunt, and 6 patients (18%) underwent mesocaval shunt. Outcomes were notable for minimal wound complications (9%), rebleeding events (12%), and mortality (3%). In the postoperative setting, 10 patients (29%) experienced a shunt complication (occlusion or stenosis), 4 of which occurred in the early postoperative period and required urgent intervention. The 1-year and 5-year "primary patency" patency rates were 71% and 66%, respectively. CONCLUSION: Children suffer significant morbidity from the sequelae of portal hypertension. Our experience reinforces the feasibility of surgical shunts as an effective treatment option associated with low rates of morbidity and mortality.


Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Hipertensão Portal/cirurgia , Derivação Portossistêmica Cirúrgica/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Criança , Pré-Escolar , Varizes Esofágicas e Gástricas/etiologia , Estudos de Viabilidade , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/complicações , Masculino , Derivação Portossistêmica Cirúrgica/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
15.
Cochrane Database Syst Rev ; 6: CD012673, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31220333

RESUMO

BACKGROUND: The presence of oesophageal varices is associated with the risk of upper gastrointestinal bleeding. Endoscopic variceal ligation is used to prevent this occurrence but the ligation procedure may be associated with complications. OBJECTIVES: To assess the beneficial and harmful effects of band ligation versus no intervention for primary prevention of upper gastrointestinal bleeding in adults with cirrhosis and oesophageal varices. SEARCH METHODS: We combined searches in the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS, and Science Citation Index with manual searches. The last search update was 9 February 2019. SELECTION CRITERIA: We included randomised clinical trials comparing band ligation verus no intervention regardless of publication status, blinding, or language in the analyses of benefits and harms, and observational studies in the assessment of harms. Included participants had cirrhosis and oesophageal varices with no previous history of variceal bleeding. DATA COLLECTION AND ANALYSIS: Three review authors extracted data independently. The primary outcome measures were all-cause mortality, upper gastrointestinal bleeding, and serious adverse events. We undertook meta-analyses and presented results using risk ratios (RRs) with 95% confidence intervals (CIs) and I2 values as a marker of heterogeneity. In addition, we calculated the number needed to treat to benefit (NNTTB) for the primary outcomes . We assessed bias control using the Cochrane Hepato-Biliary domains; determined the certainty of the evidence using GRADE; and conducted sensitivity analyses including Trial Sequential Analysis. MAIN RESULTS: Six randomised clinical trials involving 637 participants fulfilled our inclusion criteria. One of the trials included an additional small number of participants (< 10% of the total) with non-cirrhotic portal hypertension/portal vein block. We classified one trial as at low risk of bias for the outcome, mortality and high risk of bias for the remaining outcomes; the five remaining trials were at high risk of bias for all outcomes. We downgraded the evidence to moderate certainty due to the bias risk. We gathered data on all primary outcomes from all trials. Seventy-one of 320 participants allocated to band ligation compared to 129 of 317 participants allocated to no intervention died (RR 0.55, 95% CI 0.43 to 0.70; I2 = 0%; NNTTB = 6 persons). In addition, band ligation was associated with reduced risks of upper gastrointestinal bleeding (RR 0.44, 95% CI 0.28 to 0.72; 6 trials, 637 participants; I2 = 61%; NNTTB = 5 persons), serious adverse events (RR 0.55, 95% CI 0.43 to 0.70; 6 trials, 637 participants; I2 = 44%; NNTTB = 4 persons), and variceal bleeding (RR 0.43, 95% CI 0.27 to 0.69; 6 trials, 637 participants; I² = 56%; NNTTB = 5 persons). The non-serious adverse events reported in association with band ligation included oesophageal ulceration, dysphagia, odynophagia, retrosternal and throat pain, heartburn, and fever, and in the one trial involving participants with either small or large varices, the incidence of non-serious side effects in the banding group was much higher in those with small varices, namely ulcers: small versus large varices 30.5% versus 8.7%; heartburn 39.2% versus 17.4%. No trials reported on health-related quality of life.Two trials did not receive support from pharmaceutical companies; the remaining four trials did not provide information on this issue. AUTHORS' CONCLUSIONS: This review found moderate-certainty evidence that, in patients with cirrhosis, band ligation of oesophageal varices reduces mortality, upper gastrointestinal bleeding, variceal bleeding, and serious adverse events compared to no intervention. It is unlikely that further trials of band ligation versus no intervention would be considered ethical.


Assuntos
Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/prevenção & controle , Cirrose Hepática/complicações , Adulto , Varizes Esofágicas e Gástricas/mortalidade , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Humanos , Hipertensão Portal/complicações , Ligadura/efeitos adversos , Ligadura/instrumentação , Ligadura/métodos , Ligadura/mortalidade , Pessoa de Meia-Idade , Números Necessários para Tratar , Prevenção Primária/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Conduta Expectante
16.
World J Surg ; 43(10): 2623-2630, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31243526

RESUMO

BACKGROUND: The long-term patency of the portal vein (PV) in patients who survive after pancreaticoduodenectomy (PD) remains unclear. The aim of the present study was to investigate the clinical features and risk factors for benign PV stenosis after PD. METHODS: We retrospectively analyzed the patients who underwent PD from September 2002 and December 2015 at our institution without intraoperative radiation therapy or concomitant PV resection. The postoperative computed tomography of each patient was evaluated, and PV stenosis was defined as the shortest diameter of the PV being <3 mm. The patients with PV stenosis due to local recurrence were excluded. RESULTS: Of the 458 patients, PV stenosis occurred in 57 (12.4%), including benign PV stenosis in 28 (6.1%) and PV stenosis due to local recurrence in 29 (6.3%). Of the 28 patients with benign PV stenosis, 7 (25%) developed symptoms related to portal hypertension, namely recurrent gastrointestinal bleeding in 5 and refractory ascites in 2. Six patients were treated with percutaneous transhepatic PV stent placement, and all of their symptoms improved. A multivariate analysis found that a postoperative pancreatic fistula was an independent risk factor for benign PV stenosis after PD (odds ratio, 4.36; p = 0.005). CONCLUSIONS: Postoperative pancreatic fistula was a significant risk factor for benign PV stenosis after PD. Stent placement for benign PV stenosis was effective for the patients with symptoms due to portal hypertension.


Assuntos
Pancreaticoduodenectomia/efeitos adversos , Veia Porta/patologia , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Constrição Patológica/etiologia , Feminino , Humanos , Hipertensão Portal/complicações , Masculino , Pessoa de Meia-Idade , Fístula Pancreática/complicações , Estudos Retrospectivos , Stents
17.
BMJ Case Rep ; 12(5)2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31147407

RESUMO

A 50-year-old woman presented with worsening fatigue and shortness of breath. For 2 months, she has been having increased craving for unpeeled lemons and was seen in clinic about a month prior to presentation at the emergency room. At that time, she was asymptomatic except for endorsing craving for lemons. Physical exam findings at presentation noted obesity, sinus tachycardia, pallor, mild scleral jaundice and no other stigmata for chronic liver disease. Her labs suggested iron-deficiency anaemia (IDA), elevated liver enzymes and positive antimitochondrial antibody titre. Abdominal ultrasound and CT scan showed mild scarring. She was diagnosed with primary biliary cholangitis with portal hypertension complicated by oesophageal varices and IDA. Interventions included blood transfusion, oesophageal banding and treatment with ursodeoxycholic acid. Her craving for lemons, shortness of breath and fatigue resolved within 1 week. With ongoing outpatient follow-up and oesophageal variceal surveillance, she continues to do well.


Assuntos
Anemia Ferropriva/diagnóstico , Varizes Esofágicas e Gástricas/diagnóstico , Hipertensão Portal/diagnóstico , Cirrose Hepática Biliar/diagnóstico , Pica , Administração Oral , Anemia Ferropriva/sangue , Anemia Ferropriva/complicações , Anemia Ferropriva/tratamento farmacológico , Transfusão de Sangue , Colagogos e Coleréticos/administração & dosagem , Colagogos e Coleréticos/uso terapêutico , Diagnóstico Diferencial , Procedimentos Cirúrgicos do Sistema Digestório , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/cirurgia , Feminino , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/terapia , Ferro/administração & dosagem , Ferro/uso terapêutico , Cirrose Hepática Biliar/complicações , Cirrose Hepática Biliar/diagnóstico por imagem , Cirrose Hepática Biliar/terapia , Pessoa de Meia-Idade , Ultrassonografia , Ácido Ursodesoxicólico/administração & dosagem , Ácido Ursodesoxicólico/uso terapêutico
20.
Rev Gastroenterol Peru ; 39(1): 64-69, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31042238

RESUMO

Hepatic hydrothorax is uncommon transudative pleural effusion greater than 500 ml in association with cirrhosis and portal hypertension. Ascites is also present in most of the patients and the pathophysiology include the passage of ascites fluid through small diaphragmatic defects. After diagnostic thoracentesis studies, the first line management is restricting sodium intake and diuretics combination including stepwise dose of spironolactone plus furosemide. Therapeutic thoracentesis is a simple and effective procedure to relief dyspnea. Hepatic hydrothorax is refractory in approximately 20-25% and treatments options include repeated thoracentesis, transjugular intrahepatic portosystemic shunts (TIPS) placement, chemical pleurodesis with repair diaphragmatic defects using video-assisted thoracoscopy surgery (VATS), and insertion of an indwelling pleural catheter. Chest tube insertion carries significant morbidity and mortality with questionable benefit. Hepatic transplantation remains the best treatment option with long term survival. We present three cases of hepatic hydrothorax with different therapeutic approach including first line management, failed chest tube insertion and TIPS placement.


Assuntos
Hidrotórax/terapia , Idoso , Ascite/terapia , Tubos Torácicos , Terapia Combinada , Tratamento Conservador , Diuréticos/uso terapêutico , Feminino , Hepatite C/complicações , Humanos , Hidrotórax/etiologia , Hidrotórax/cirurgia , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Transplante de Fígado , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Derrame Pleural/terapia , Pleurodese , Derivação Portossistêmica Transjugular Intra-Hepática , Toracentese
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