Effectiveness of beta blockers in primary prophylaxis of variceal bleeding in children with portal hypertension.
OBJECTIVE
The primary aim of our study was to assess the effectiveness of beta blockers in non bleeding portal hypertensive children. The secondary objective was to evaluate whether the newer generation beta blockers were superior compared to conventional ones.


METHODS
Conventional propranolol and newer generation carvedilol were administered to 31 subjects each, after stratifying them into nearly equal subgroups according to etiology (sinusoidal or presinusoidal).


RESULTS
At the end of 2 years study period, 3 children (4.83%) had breakthrough bleeding. A decrease, increase and no alteration in grade of oesophageal varices was seen in 40, 9 and 13 cases respectively. Of the 9 children with associated gastroeosophageal varices (GOV), the severity of lesions was reduced in 8 of them. Both the drugs had efficacious outcome in sinusoidal as well as presinusoidal cases, having a significant coefficient of correlation (r > 0.5) with time. Carvedilol was more effective than propranolol statistically (p = 0.035 and p = 0.034 respectively), only at 4 and 5 month follow-up period.


CONCLUSIONS
Beta blockers are effective in preventing variceal bleed in children with portal hypertension. Long-term efficacy of carvedilol and propranolol was similar.
Department of Pediatric Medicine, Nilratan Sircar Medical College and Hospital, Kolkata, India. ts_ped@rediffmail.com
Tryambak
T
Samanta
Radheshyam
R
Purkait
Mihir
M
Sarkar
Abhijit
A
Misra
Sutapa
S
Ganguly
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D002648:Child; D002675:Child, Preschool; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008297:Male; D011412:Propanolamines / Q000627:therapeutic use*; D011433:Propranolol / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D011433:Propranolol