title: Management of digestive bleeding related to portal hypertension in cirrhotic patients: A French multicenter cross-sectional practice survey.
abstract: 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.
authors.affiliation: 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
authors.forename: Pierre
authors.initials: P
authors.lastname: Ingrand
authors.forename: Jerome
authors.initials: J
authors.lastname: Gournay
authors.forename: Pierre
authors.initials: P
authors.lastname: Bernard
authors.forename: Frederic
authors.initials: F
authors.lastname: Oberti
authors.forename: Brigitte
authors.initials: B
authors.lastname: Bernard-Chabert
authors.forename: Arnault
authors.initials: A
authors.lastname: Pauwels
authors.forename: Philippe
authors.initials: P
authors.lastname: Renard
authors.forename: Eric
authors.initials: E
authors.lastname: Bartoli
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Cadranel
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Barbare
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ingrand
authors.forename: Michel
authors.initials: M
authors.lastname: Beauchant
mesh_terms: 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
chemical_list: D000319:Adrenergic beta-Antagonists; D014662:Vasoconstrictor Agents