Novel approaches to treat portal hypertension

Portal vein thrombosis

Portal vein thrombosis (PVT) can be a difficult clinical problem to assess and manage. A high index of suspicion is needed for a PVT diagnosis given the subtle presentation and potentially serious long-term complications. It should be considered a clue to the presence of one or several underlying disorders, including prothrombotic disorders, whether or not a local precipitating factor is identified. The accruing evidence shows that acute PVT can and probably should be treated with anticoagulation or thrombolytic agents in an effort to prevent extension of thrombus, mesenteric vessel occlusion, and portal hypertension. However, chronic PVT should be treated conservatively with measures to control major consequences related to portal hypertension. Anticoagulation therapy duration should be tailored to the identified predisposing factors.

Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology

In the last decades, several improvements in the management of variceal bleeding have resulted in a significant decrease in morbidity and mortality of patients with cirrhosis and bleeding varices. Progress in the multidisciplinary approach to these patients has led to a better management of this disease by critical care physicians, hepatologists, gastroenterologists, endoscopists, radiologists and surgeons. In this respect, the Brazilian Society of Hepatology has, recently, sponsored a consensus meeting in order to draw evidence-based recommendations on the management of these difficult-to-treat subjects. An organizing committee comprised of four people was elected by the Governing Board and was responsible to invite 27 researchers from distinct regions of the country to make a systematic review of the subject and to present topics related to variceal bleeding, including prevention, diagnosis, management and treatment, according to evidence-based medicine. After the meeting, all participants met together for discussion of the topics and the elaboration of the aforementioned recommendations. The organizing committee was responsible for writing the final document. The meeting was held at Salvador, May 6th, 2009 and the present manuscript is the summary of the systematic review that was presented during the meeting, organized in topics, followed by the recommendations of the Brazilian Society of Hepatology.

A multicentred clinical comparative study on curative effect and safety of acetic octreotide in treatment of esophageal varices bleeding

AIM: To evaluate curative effect and safety of acetic octreotide in the treatment of esophageal varices blee-ding (EVB) in comparison with octreotide (Sandostatin).

METHODS: EVB patients were randomly and double-blinded assigned into acetic octreotide group (n = 70) and Sandostatin group (n = 66). Both kinds of drugs were dissolved in normal saline and then given to the patients at the rate of 50 mg/h for 48 h. The amount of bleeding and vital signs of all the patients were observed and comparatively analyzed.

RESULTS: The frequencies and amount of hemateme-sis, the excreted frequencies and amount of black feces were significantly different before and after treatment with both kinds of drugs (P <0.05), but there was no marked difference between the two groups (P >0.05). The vital signs such as heart rate, systolic and diastolic blood pressure as well as symptoms of nausea, swirling, heart-throb, sweatiness, and thirst were notably improved after treatment (P <0.05), but there was still no obvious difference between the two groups (P >0.05). Adverse drug reaction was also different between the two groups 1.43% (1.43% vs 1.52%, P >0.05). The total effective rates in acetic octreotide and Sandostatin group were 97.14% and 92.42%, respectively (P >0.05).

CONCLUSION: Acetic octreotide is safe and effective in the treatment of EVB, and its effect is not significan-tly different from Sandostatin's.