Contemporary concepts of prevention and treatment of gastroesophageal variceal bleeding in liver cirrhosis patients (based on the BAVENO VII consensus conference materials, October 2021)
Abstract
Objective. To describe contemporary concepts of prevention and treatment of gastroesophageal variceal bleeding in liver cirrhosis patients according to the Baveno VII consensus conference recommendations. Key points. In the absence of clinically significant portal hypertension, etiological and non-aetiological therapies of liver cirrhosis is advisable for the primary prevention of gastroesophageal variceal bleeding, whereas its presence serves as an indication for the administration of non-selective β-blockers, among which carvedilol is the drug of choice. Non-selective β-blockers, as well as endoscopic variceal ligation and transjugular intrahepatic portosystemic shunt can be used to prevent recurrence of gastroesophageal variceal bleeding. Pharmacotherapy with vasoactive drugs (terlipressin, somatostatin, octreotide), endoscopic variceal ligation, endovascular techniques and transjugular intrahepatic portosystemic shunt are recommended for the treatment of acute gastroesophageal variceal bleeding. Conclusions. Objective and accurate stratification of the risk of gastroesophageal variceal bleeding will allow to develop individual strategies for their prevention and treatment, which will improve the prognosis and survival of liver cirrhosis patients.
About the Author
D. V. Garbuzenko
South-Urals State Medical University
Russian Federation
Russian Federation
Chelyabinsk
References
1. Jalan, R. New clinical and pathophysiological perspectives defining the trajectory of cirrhosis / R. Jalan, G. D’Amico, J. Trebicka, R. Moreau, P. Angeli, V. Arroyo // J. Hepatol. - 2021. - Vol. 75 (Suppl 1). - P. 14-26.
2. D'Amico, G. Towards a new definition of decompensated cirrhosis / G. D'Amico, M. Bernardi, P. Angeli / J. Hepatol. - 2022. - Vol. 76, № 1. - P. 202-207.
3. D'Amico, G. Clinical states of cirrhosis and competing risks / G. D'Amico, A. Morabito, M. D'Amico, L. Pasta, G. Malizia, P. Rebora, et al. // J. Hepatol. - 2018. - Vol. 68, № 3. - P. 563-576.
4. de Franchis, R. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension / R. de Franchis; Baveno VI Faculty // J. Hepatol. - 2015. - Vol. 63, № 3. - P. 743-752.
5. de Franchis, R. Baveno VII - Renewing consensus in portal hypertension / R. de Franchis, J. Bosch, G. Garcia-Tsao, T. Reiberger, C. Ripoll; Baveno VII Faculty // J. Hepatol. - 2022. - Vol. 76, № 4. - P. 959-974.
6. Bosch, J. Measurement of portal pressure and its role in the management of chronic liver disease / J. Bosch, J.C. Garcia-Pagán, A. Berzigotti, J. C. Abraldes // Semin. Liver Dis. - 2006. - Vol. 26, № 4. - P. 348-362.
7. Karagiannakis, D. S. Evaluation of portal hypertension in the cirrhotic patient: hepatic vein pressure gradient and beyond / D. S. Karagiannakis, T. Voulgaris, S.T. Siakavellas, G. V. Papatheodoridis, J. Vlachogiannakos // Scand. J. Gastroenterol. - 2018. - Vol. 53, № 10-11. - P. 1153-1164.
8. Павлов, Ч. С. Современные возможности эластометрии, фибро- и акти-теста в диагностике фиброза печени / Ч. С. Павлов, Д. В. Глушенков, В. Т. Ивашкин // Рос. журн. гастроэнтерол. гепатол. колопроктол. - 2008. - Т. 18, № 4. - С. 43-52.
9. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; Clinical Practice Guideline Panel; Chair:; EASL Governing Board representative:; Panel members:. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis - 2021 update // J. Hepatol. - 2021. - Vol. 75, № 3. - P. 659-689.
10. Lee, E. J. Comparison of hepatic venous pressure gradient and endoscopic grading of esophageal varices / E. J. Lee, Y. J. Kim, D. E. Goo, S. B. Yang, H. J. Kim, J. Y. Jang, et al. // World J. Gastroenterol. - 2016. - Vol. 22, № 11. - P. 3212–3219.
11. Hofer, B. S. Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis / B. S. Hofer, B. Simbrunner, L. Hartl, M. Jachs, D. J. M. Bauer, L. Balcar, et al. // Clin. Gastroenterol. Hepatol. - 2023. - Vol. 21, № 9. - P. 2308-2317.
12. Гарбузенко, Д. В. Роль противовирусной терапии в лечении больных циррозом печени, ассоциированным с хронической HBV- и HCV-инфекцией / Д. В. Гарбузенко // Вопросы вирусологии. - 2021. - Т. 66, № 5. - С. 331-339.
13. Гарбузенко, Д. В. Перспективы антиангиогенной терапии портальной гипертензии при циррозе печени / Д. В. Гарбузенко // Рос. журн. гастроэнтерол., гепатол., колопроктол. – 2018. - Т. 28, № 5. - С. 35-45.
14. Гарбузенко, Д. В. Теоретические основы и терапевтический потенциал модуляции микробиоты кишечника при острой декомпенсации цирроза печени / Д. В. Гарбузенко // Доказательная гастроэнтерология. - 2022. - Т. 11, № 4. - С. 65–76.
15. Гарбузенко, Д. В. Современные стратегии таргетной терапии фиброза печени / Д. В. Гарбузенко // Бюллетень сибирской медицины. - 2022. - Т. 21, № 3. - С. 154–165.
16. Гарбузенко, Д. В. Принципы первичной профилактики кровотечений из варикозно расширенных вен пищевода у больных с циррозом печени / Д. В. Гарбузенко // Клиническая медицина. - 2016. - Т. 94, № 7. - С. 503-509.
17. Wong, Y. J. Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients // Y. J. Wong, C. Zhaojin, G. Tosetti, E. Degasperi, S. Sharma, S. Agarwal, et al. // Clin. Mol. Hepatol. - 2023. - Vol. 29, № 1. - P. 135-145.
18. Villanueva, C. β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial / C. Villanueva, A. Albillos, J. Genescà, J. C. Garcia-Pagan, J. L. Calleja, C. Aracil, et al. // Lancet. - 2019. - Vol. 393, № 10181. - P. 1597-1608.
19. Turco, L. Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-Analysis / L. Turco, C. Villanueva, V. La Mura, J. C. García-Pagán, T. Reiberger, J. Genescà, et al. // Clin. Gastroenterol. Hepatol. - 2020. - Vol. 18, № 2. - P. 313-327.
20. Гарбузенко, Д. В. Аспекты патогенетической фармакотерапии портальной гипертензии при циррозе печени / Д. В. Гарбузенко // Терапевтический архив. - 2016. - Т. 88, № 2. – С. 101-108.
21. Ивашкин, В. Т. Клинические рекомендации Российского общества по изучению печени и Российской гастроэнтерологической ассоциации по диагностике и лечению фиброза и цирроза печени и их осложнений / В. Т. Ивашкин, М. В. Маевская, М. С. Жаркова, С. Б. Жигалова, Е. А. Киценко и др. // Рос. журн. гастроэнтерол. гепатол. колопроктол. - 2021. - Т. 31, № 6. - С. 56–102.
22. Aguilar-Olivos, N. Hemodynamic effect of carvedilol vs. propranolol in cirrhotic patients: Systematic review and metaanalysis / N. Aguilar-Olivos, M. Motola-Kuba, R. Candia, M. Arrese, N. Méndez-Sánchez, M. Uribe, et al. // Ann. Hepatol. - 2014. - Vol. 13, № 4. - P. 420-428.
23. Sinagra, E. Systematic review with meta-analysis: the haemodynamic effects of carvedilol compared with propranolol for portal hypertension in cirrhosis / E. Sinagra, G. Perricone, M. D'Amico, F. Tinè, G. D'Amico // Aliment. Pharmacol. Ther. - 2014. - Vol. 39, № 6. - P. 557-568.
24. Reiberger, T. Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response to propranolol / T. Reiberger, G. Ulbrich, A. Ferlitsch, B. A. Payer, P. Schwabl, M. Pinter, et al. // Gut. - 2013. - Vol. 62, № 11. - P. 1634-1641.
25. Kirnake, V. Hemodynamic Response to Carvedilol is Maintained for Long Periods and Leads to Better Clinical Outcome in Cirrhosis: A Prospective Study / V. Kirnake, A. Arora, V. Gupta, P. Sharma, V. Singla, N. Bansal, et al. // J. Clin. Exp. Hepatol. - 2016. - Vol. 6, № 3. - P. 175-185.
26. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis // J. Hepatol. - 2018. - Vol. 69, № 2. - P. 406-460.
27. Thiele, M. Meta-analysis: banding ligation and medical interventions for the prevention of rebleeding from oesophageal varices / M. Thiele, A. Krag, U. Rohde, L. L. Gluud // Aliment. Pharmacol. Ther. - 2012. - Vol. 35, № 10. - P. 1155-1165.
28. Pfisterer, N. Betablockers do not increase efficacy of band ligation in primary prophylaxis but they improve survival in secondary prophylaxis of variceal bleeding / N. Pfisterer, C. Dexheimer, E. M. Fuchs, T. Bucsics, P. Schwabl, M. Mandorfer, et al. // Aliment. Pharmacol. Ther. - 2018. - Vol. 47, № 7. - P. 966-979.
29. Dardari, L. The Efficacy of Carvedilol in Comparison to Propranolol in Reducing the Hepatic Venous Pressure Gradient and Decreasing the Risk of Variceal Bleeding in Adult Cirrhotic Patients: A Systematic Review / L. Dardari, M. Taha, P. Dahat, S. Toriola, T. Satnarine, Z. Zohara, et al. // Cureus. - 2023. - Vol. 15, № 8. - e43253.
30. Reiberger, T. Beta adrenergic blockade and decompensated cirrhosis / T. Reiberger, M. Mandorfer // J. Hepatol. - 2017. - Vol. 66, № 4. - P. 849-859.
31. Larrue, H. TIPS prevents further decompensation and improves survival in patients with cirrhosis and portal hypertension in an individual patient data meta-analysis / H. Larrue, G. D'Amico, P. Olivas, Y. Lv, T. Bucsics, M. Rudler, et al. // J. Hepatol. - 2023. - Vol. 79, № 3. - P. 692-703.
32. Гарбузенко, Д. В. Лечение больных циррозом печени с кровотечением из варикозно-расширенных вен пищевода / Д. В. Гарбузенко // Врач. - 2015. - № 10. - С. 15-21.
33. Huaringa-Marcelo, J. Vasoactive Agents for the Management of Acute Variceal Bleeding: A Systematic Review and Metaanalysis / J. Huaringa-Marcelo, M. R. Huaman, A. Brañez-Condorena, P. Villacorta-Landeo, D. F. Pinto-Ruiz, D. Urday-Ipanaqué, et al. // J. Gastrointestin. Liver Dis. - 2021. - Vol. 30, № 1. - P. 110-121.
34. Hwang, S. J. Correlation Between Proton Pump Inhibitors and the Complications of Liver Cirrhosis: A Systematic Review and Meta-Analysis / S. J. Hwang, D. H. Lee, S. J. Koh, J. W. Kim, H. S. Park, B. G. Kim, et al. // Turk. J. Gastroenterol. - 2022. - Vol. 33, № 1. - P. 44-52.
35. Chavez-Tapia, N. C. Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding - an updated Cochrane review / N. C. Chavez-Tapia, T. Barrientos-Gutierrez, F. Tellez-Avila, K. Soares-Weiser, N. Mendez-Sanchez, C. Gluud, et al. // Aliment. Pharmacol. Ther. - 2011. - Vol. 34, № 5. - P. 509-518.
36. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines on nutrition in chronic liver disease // J. Hepatol. - 2019. - Vol. 70, № 1. - P. 172-193.
37. Garcia-Tsao, G. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases / G. Garcia-Tsao, J. G. Abraldes, A. Berzigotti, J. Bosch // Hepatology. - 2017. - Vol. 65, № 1. - P. 310-335.
38. Yan, P. Is additional 5-day vasoactive drug therapy necessary for acute variceal bleeding after successful endoscopic hemostasis?: A systematic review and meta-analysis / P. Yan, X. Tian, J. Li // Medicine (Baltimore). - 2018. - Vol. 97, № 41. - e12826.
39. Henry, Z. AGA Clinical Practice Update on Management of Bleeding Gastric Varices: Expert Review / Z. Henry, K. Patel, H. Patton, W. Saad // Clin. Gastroenterol. Hepatol. - 2021. - Vol. 19, № 6. - P. 1098-1107.
40. Boike, J. R. North American Practice-Based Recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension / J. R. Boike, B. G. Thornburg, S. K. Asrani, M. B. Fallon, B. E. Fortune, M. J. Izzy, et al. // Clin. Gastroenterol. Hepatol. - 2022. - Vol. 20, № 8. - P. 1636-1662.
41. Lv, Y. Early TIPS with covered stents versus standard treatment for acute variceal bleeding in patients with advanced cirrhosis: a randomised controlled trial / Y. Lv, Z. Yang, L. Liu, K. Li, C. He, Z. Wang, et al. // Lancet Gastroenterol. Hepatol. - 2019. - Vol. 4, № 8. - P. 587-598.
42. O'Leary, J. G. AGA Clinical Practice Update: Coagulation in Cirrhosis / J. G. O'Leary, C. S. Greenberg, H. M. Patton, S. H. Caldwell // Gastroenterology. - 2019. - Vol. 157, № 1. - P. 34-43.
43. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis // J. Hepatol. - 2022. - Vol. 76, № 5. - P. 1151-1184.
44. Mohanty, A. Fresh frozen plasma transfusion in acute variceal haemorrhage: Results from a multicentre cohort study / A. Mohanty, D. Kapuria, A. Canakis, H. Lin, M. J. Amat, G. Rangel Paniz, et al. // Liver Int. - 2021. - Vol. 41, № 8. - P. 1901-1908.
45. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatic encephalopathy // J. Hepatol. - 2022. - Vol. 77, № 3. - P. 807-824.
Review
For citations:
Garbuzenko D.V. Contemporary concepts of prevention and treatment of gastroesophageal variceal bleeding in liver cirrhosis patients (based on the BAVENO VII consensus conference materials, October 2021). Title in english. 2024;19(2):32-38. (In Russ.)
Views:
88
Email this article 