TY - JOUR
T1 - Pharmacologic efficacy in gastric variceal rebleeding and survival
T2 - Including multivariate analysis
AU - Wu, Chun Ying
AU - Yeh, Hong Zen
AU - Chen, Gran Hum
PY - 2002
Y1 - 2002
N2 - Background: Therapy with β-blocker and nitrate has been reported to improve survival of patients with bleeding esophageal varices and to decrease esophageal rebleeding. However, there is little information available concerning the efficacy of these medications on rebleeding risk and survival in gastric variceal bleeding after initial hemostasis. Methods: We conducted an open trial to observe the roles of β-blocker and nitrate in the long-term outcome of bleeding gastric varices. Eighty-three patients were included and evaluated on the basis of age, gender, gastric variceal size, associated esophageal variceal size, Child-Pugh classification, existence of hepatoma and portal vein thrombosis, β-blocker or nitrate therapy, and follow-up histoacryl injection. Survival analysis and multivariate analysis with the Cox proportional hazards model were performed to evaluate independent risk factors. Results: Larger gastric varices have been shown to be the only risk factor for rebleeding (adjusted odds ratio, 4.50; 95% CI, 1.30-15.59). β-Blocker and nitrate did not significantly reduce the incidence of rebleeding (adjusted odds ratio, 0.37; 95% CI, 0.08-1.66). Although medical treatment was shown to improve the overall survival by Kaplan-Meier method (p < 0.01), multivariate analysis showed Child-Pugh class B or C and advanced hepatoma with portal vein thrombosis to be the real independent risk factors that influence survival (Child-Pugh class B or C odds ratio, 2.72; 95% CI, 1.53-4.84; portal vein thrombosis odds ratio, 6.99; 95% CI, 2.42-20.16). β-Blocker and nitrate did not significantly prolong survival independently. Conclusions: β-Blocker and nitrate did not decrease the risk of rebleeding and did not improve the overall survival independently. The poor prognosis was correlated with Child-Pugh class B or C, and the advance hepatoma, with portal vein thrombosis.
AB - Background: Therapy with β-blocker and nitrate has been reported to improve survival of patients with bleeding esophageal varices and to decrease esophageal rebleeding. However, there is little information available concerning the efficacy of these medications on rebleeding risk and survival in gastric variceal bleeding after initial hemostasis. Methods: We conducted an open trial to observe the roles of β-blocker and nitrate in the long-term outcome of bleeding gastric varices. Eighty-three patients were included and evaluated on the basis of age, gender, gastric variceal size, associated esophageal variceal size, Child-Pugh classification, existence of hepatoma and portal vein thrombosis, β-blocker or nitrate therapy, and follow-up histoacryl injection. Survival analysis and multivariate analysis with the Cox proportional hazards model were performed to evaluate independent risk factors. Results: Larger gastric varices have been shown to be the only risk factor for rebleeding (adjusted odds ratio, 4.50; 95% CI, 1.30-15.59). β-Blocker and nitrate did not significantly reduce the incidence of rebleeding (adjusted odds ratio, 0.37; 95% CI, 0.08-1.66). Although medical treatment was shown to improve the overall survival by Kaplan-Meier method (p < 0.01), multivariate analysis showed Child-Pugh class B or C and advanced hepatoma with portal vein thrombosis to be the real independent risk factors that influence survival (Child-Pugh class B or C odds ratio, 2.72; 95% CI, 1.53-4.84; portal vein thrombosis odds ratio, 6.99; 95% CI, 2.42-20.16). β-Blocker and nitrate did not significantly prolong survival independently. Conclusions: β-Blocker and nitrate did not decrease the risk of rebleeding and did not improve the overall survival independently. The poor prognosis was correlated with Child-Pugh class B or C, and the advance hepatoma, with portal vein thrombosis.
KW - Gastric varices
KW - Nitrate
KW - Rebleeding
KW - Survival
KW - β-Blocker
UR - http://www.scopus.com/inward/record.url?scp=0036020423&partnerID=8YFLogxK
U2 - 10.1097/00004836-200208000-00002
DO - 10.1097/00004836-200208000-00002
M3 - Article
C2 - 12172356
AN - SCOPUS:0036020423
SN - 0192-0790
VL - 35
SP - 127
EP - 132
JO - Journal of Clinical Gastroenterology
JF - Journal of Clinical Gastroenterology
IS - 2
ER -