Management of digestive bleeding related to portal hypertension in cirrhotic patients: A French multicenter cross-sectional practice survey.
OBJECTIVE
To investigate the conformity of management practices of gastrointestinal hemorrhage in cirrhotic patients with relevant guidelines.


METHODS
A questionnaire on the management of digestive bleeding was completed for all consecutive cirrhotic patients admitted to 31 French hospitals.


RESULTS
One hundred and twenty-six bleeding events were recorded. It was the first bleeding episode in 79 patients (63%), of whom 40 (51%) had a prior diagnosis of cirrhosis and 25 (32%) had previously undergone an endoscopy. The bleeding episode was a recurrence in 46 patients (37%). The median time between onset and admission was 4 h, but exceeded 12 h in 42% of cases. There was an agreement between centers for early vasoactive drug administration (87% of cases), association with ligation (42%) more often than sclerosis (21%) at initial endoscopy, and antibiotic prophylaxis (64%). By contrast, prescription of beta-blockade alone or in combination (0 to 100%, P = 0.003) for secondary prophylaxis and lactulose (26% to 86%, P = 0.04), differed among centers.


CONCLUSIONS
In French hospitals, management of bleeding related to portal hypertension in cirrhotic patients is generally in keeping with the consensus. Broad variability still remains concerning beta-blockade use for secondary prophylaxis. Screening for esophageal varices, the use of antibiotic prophylaxis and patients information need to be improved.
Ingrand
Pierre
P
Clinical Research Center, FacultA de MAdecine et de Pharmacie, 34 rue du Jardin des Plantes, BP 199, 86005 POITIERS, Cedex, France. pierre.ingrand@univ-poitiers.fr
Gournay
Jerome
J
Bernard
Pierre
P
Oberti
Frederic
F
Bernard-Chabert
Brigitte
B
Pauwels
Arnault
A
Renard
Philippe
P
Bartoli
Eric
E
Cadranel
Jean-Francois
JF
Barbare
Jean-Claude
JC
Ingrand
Isabelle
I
Beauchant
Michel
M
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D014662:Vasoconstrictor Agents