Pharmacologic treatment of portal hypertension in the prevention of community-acquired spontaneous bacterial peritonitis.
BACKGROUND
Given that beta-blockers reduce the incidence of bacterial translocation in cirrhotic rats, the aim of this study was to compare the long-term incidence of spontaneous bacterial peritonitis in cirrhotic patients submitted to pharmacologic versus endoscopic treatment to prevent variceal rebleeding.


METHODS
Two hundred and thirty patients with variceal hemorrhage were included in two previous randomized trials performed to compare the efficacy of medication (nadolol plus isosorbide mononitrate, n=115) versus endoscopic treatment (n=115) with sclerotherapy or ligation for the prevention of rebleeding.


RESULTS
The mean follow-up was 23+/-1.4 months. The characteristics of the patients and the number of patients on long-term prophylaxis with norfloxacin were similar in both groups. The incidence of spontaneous bacterial peritonitis was lower in the medication group (9 versus 14.7%, P=NS). The probability of spontaneous bacterial peritonitis was also lower in the medication group (6 versus 12% at 1 year, 22 versus 36% at 5 years; P=0.08), due to a significantly lower probability of community-acquired spontaneous bacterial peritonitis in this group (1 versus 10% at 1 year, 18 versus 32% at 5 years; P=0.02). Patients with no hemodynamic response to therapy had a significantly higher probability to develop community-acquired spontaneous bacterial peritonitis during follow-up than hemodynamic responders (P<0.03). Long-term probability of developing community-acquired spontaneous bacterial peritonitis is lower in patients submitted to pharmacologic treatment for preventing variceal rebleeding than in those submitted to endoscopic treatment.


CONCLUSIONS
Long-term pharmacologic prophylaxis of variceal rebleeding contributes to the prevention of community-acquired spontaneous bacterial peritonitis.
Gonzalez-Suarez
Begoña
B
Gastroenterology Department, Hospital Sant Pau, Barcelona, Spain. bgonzalezs@hsp.santpau.es
Guarner
Carlos
C
Villanueva
Candid
C
Minana
Josep
J
Soriano
German
G
Gallego
Adolfo
A
Sainz
Sergio
S
Torras
Xavier
X
Cusso
Xavier
X
Balanzo
Joaquim
J
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D017714:Community-Acquired Infections / Q000209:etiology / Q000517:prevention & control; D004359:Drug Therapy, Combination; D004812:Epidemiologic Methods; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D004945:Esophagoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006439:Hemodynamics; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D007548:Isosorbide Dinitrate / Q000031:analogs & derivatives / Q000627:therapeutic use; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009248:Nadolol / Q000627:therapeutic use; D010538:Peritonitis / Q000209:etiology / Q000517:prevention & control*; D015911:Sclerotherapy; D055502:Secondary Prevention; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D014665:Vasodilator Agents; D009248:Nadolol; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate