Pharmacologic efficacy in gastric variceal rebleeding and survival: including multivariate analysis.
BACKGROUND
Therapy with beta-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 beta-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, beta-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). beta-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). beta-Blocker and nitrate did not significantly prolong survival independently.


CONCLUSIONS
beta-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.
Wu
Chun-Ying
CY
Section of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C. chun@vghtc.gov.tw
Yeh
Hong-Zen
HZ
Chen
Gran-Hum
GH
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular; D004932:Esophageal and Gastric Varices / Q000145:classification / Q000517:prevention & control*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000145:classification / Q000517:prevention & control*; D006801:Humans; D006975:Hypertension, Portal; D007548:Isosorbide Dinitrate / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D008113:Liver Neoplasms; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011169:Portal Vein; D011379:Prognosis; D011433:Propranolol / Q000008:administration & dosage*; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D016019:Survival Analysis; D020246:Venous Thrombosis
D000319:Adrenergic beta-Antagonists; D011433:Propranolol; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate