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 m...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.展开更多
Objective:A retrospective study was performed to compare the difference in platelet count(PLT),prothrombin time(PT),international normalized ratio(INR),and activated partial thromboplastin time(APTT),between cirrhotic...Objective:A retrospective study was performed to compare the difference in platelet count(PLT),prothrombin time(PT),international normalized ratio(INR),and activated partial thromboplastin time(APTT),between cirrhotic patients with and without acute upper gastrointestinal bleeding(AUGIB)or acute oesophageal variceal bleeding(AEVB).Methods:Between January 2012 and June 2014,a total of 1734 cirrhotic patients were enrolled and were classified into‘AUGIB’(n=497)and‘no AUGIB’(n=1237)groups according to their disease history.They were further divided into‘AEVB’(n=297)and‘no AEVB’(n=1259)groups according to the endoscopic findings.Additionally,178 patients with AUGIB were not assigned to either the‘AEVB’or‘no AEVB’groups due to the absence of any endoscopic findings.Results:Compared with the‘no AUGIB’group,the‘AUGIB’group had similar PLT(99.99689.90 vs.101.47683.03;P=0.734)and APTT(42.96±15.20 vs.43.77611.01;P=0.219),but significantly higher PT(17.30±5.62 vs.16.03±64.68;P<0.001)and INR(1.45±0.69 vs.1.316±0.59;P<0.001).A lower PT was independently associated with the absence of AUGIB(OR=0.968;95%CI:0.942–0.994).Compared with the‘no AEVB’group,the‘AEVB’group had significantly lower PLT(86.87662.14 vs.101.74683.62;P=0.004)and APTT(40.98±67.9 vs.43.72±10.97;P<0.001),but similar PT(16.53±3.71 vs.16.04±4.68;P=0.088)and INR(1.35±0.41 vs.1.31±0.59;P=0.225).A higher PLT was independently associated with the absence of AEVB(OR=1.004;95%CI:1.002–1.006;P=0.001).Conclusions:PLT was associated with the occurrence of portal hypertension-related bleeding in liver cirrhosis.展开更多
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...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.展开更多
Background and aims:Due to the invasiveness of upper gastrointestinal endoscopy,non-invasive diagnostic tests for varices in liver cirrhosis have been widely established by numerous studies.A questionnaire survey,whic...Background and aims:Due to the invasiveness of upper gastrointestinal endoscopy,non-invasive diagnostic tests for varices in liver cirrhosis have been widely established by numerous studies.A questionnaire survey,which was aimed at understanding the current knowledge about non-invasive diagnostic tests for varices in liver cirrhosis,was distributed among the members of Gastroenterology Branch of the Liaoning Medical Association.Methods:A questionnaire assessing the knowledge about non-invasive diagnostic tests for varices was sent to 42 members who participated in the entire ninth committee.They were from 33 hospitals in 13 cities of Liaoning Province,China.Results:Overall,97.6%(41/42)of participants responded to the questionnaire.A majority of participants were chief physicians(85.4%),had>20 years of experience in clinical work of digestive diseases(80.5%)and worked at tertiary hospitals(97.6%).In 46.3%of participants’departments,there were>200 patients with liver cirrhosis and gastroesophageal varices admitted every year.In 90.2%of participants’departments,upper gastrointestinal endoscopy was regularly employed for the diagnosis of gastroesophageal varices.Only six(15%)participants often used non-invasive diagnostic tests for varices in clinical practice.Thirty(75%)participants knew at least one non-invasive diagnostic test for varices.The knowledge of at least one non-invasive diagnostic test was significantly associated with the number of cirrhotic patients with varices(P¼0.038)or the regular use of gastrointestinal endoscopy to diagnose varices(P¼0.022).Conclusions:This questionnaire survey suggested that non-invasive diagnostic tests for varices in liver cirrhosis were rarely or never used in clinical practices in Liaoning Province,China.Reliable,non-invasive indexes should be further explored in a well-designed multi-center observational study.展开更多
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)ar...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.展开更多
文摘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.
基金This study was partially supported by the grant from the National Natural Science Foundation of China(no.81500474)Natural Science Foundation of Liaoning Province(no.2015020409).
文摘Objective:A retrospective study was performed to compare the difference in platelet count(PLT),prothrombin time(PT),international normalized ratio(INR),and activated partial thromboplastin time(APTT),between cirrhotic patients with and without acute upper gastrointestinal bleeding(AUGIB)or acute oesophageal variceal bleeding(AEVB).Methods:Between January 2012 and June 2014,a total of 1734 cirrhotic patients were enrolled and were classified into‘AUGIB’(n=497)and‘no AUGIB’(n=1237)groups according to their disease history.They were further divided into‘AEVB’(n=297)and‘no AEVB’(n=1259)groups according to the endoscopic findings.Additionally,178 patients with AUGIB were not assigned to either the‘AEVB’or‘no AEVB’groups due to the absence of any endoscopic findings.Results:Compared with the‘no AUGIB’group,the‘AUGIB’group had similar PLT(99.99689.90 vs.101.47683.03;P=0.734)and APTT(42.96±15.20 vs.43.77611.01;P=0.219),but significantly higher PT(17.30±5.62 vs.16.03±64.68;P<0.001)and INR(1.45±0.69 vs.1.316±0.59;P<0.001).A lower PT was independently associated with the absence of AUGIB(OR=0.968;95%CI:0.942–0.994).Compared with the‘no AEVB’group,the‘AEVB’group had significantly lower PLT(86.87662.14 vs.101.74683.62;P=0.004)and APTT(40.98±67.9 vs.43.72±10.97;P<0.001),but similar PT(16.53±3.71 vs.16.04±4.68;P=0.088)and INR(1.35±0.41 vs.1.31±0.59;P=0.225).A higher PLT was independently associated with the absence of AEVB(OR=1.004;95%CI:1.002–1.006;P=0.001).Conclusions:PLT was associated with the occurrence of portal hypertension-related bleeding in liver cirrhosis.
基金Supported by the National Natural Science Foundation of China,No.81500474Training Programme Foundation for Beijing Talents,No.2016000021469G206
文摘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.
文摘Background and aims:Due to the invasiveness of upper gastrointestinal endoscopy,non-invasive diagnostic tests for varices in liver cirrhosis have been widely established by numerous studies.A questionnaire survey,which was aimed at understanding the current knowledge about non-invasive diagnostic tests for varices in liver cirrhosis,was distributed among the members of Gastroenterology Branch of the Liaoning Medical Association.Methods:A questionnaire assessing the knowledge about non-invasive diagnostic tests for varices was sent to 42 members who participated in the entire ninth committee.They were from 33 hospitals in 13 cities of Liaoning Province,China.Results:Overall,97.6%(41/42)of participants responded to the questionnaire.A majority of participants were chief physicians(85.4%),had>20 years of experience in clinical work of digestive diseases(80.5%)and worked at tertiary hospitals(97.6%).In 46.3%of participants’departments,there were>200 patients with liver cirrhosis and gastroesophageal varices admitted every year.In 90.2%of participants’departments,upper gastrointestinal endoscopy was regularly employed for the diagnosis of gastroesophageal varices.Only six(15%)participants often used non-invasive diagnostic tests for varices in clinical practice.Thirty(75%)participants knew at least one non-invasive diagnostic test for varices.The knowledge of at least one non-invasive diagnostic test was significantly associated with the number of cirrhotic patients with varices(P¼0.038)or the regular use of gastrointestinal endoscopy to diagnose varices(P¼0.022).Conclusions:This questionnaire survey suggested that non-invasive diagnostic tests for varices in liver cirrhosis were rarely or never used in clinical practices in Liaoning Province,China.Reliable,non-invasive indexes should be further explored in a well-designed multi-center observational study.
文摘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.
