title: Effects of propranolol or propranolol plus isosorbide-5-mononitrate on variceal pressure in schistosomiasis.
abstract: OBJECTIVE
  To compare the effects of propranolol (PR) to that of PR plus isosorbide-5-mononitrate (ISMN) on variceal pressure in patients with schistosomiasis.
  
  
  METHODS
  Forty-eight patients with schistosomiasis who had no previous variceal bleeding were treated with PR alone or PR plus ISMN. Seven patients refused variceal pressure manometry (3 receiving PR and 4 receiving PR plus ISMN). One patient withdrew from the trial due to headache after taking ISMN. At the time of termination, twenty patients were randomly assigned to treatment with PR plus ISMN or PR alone. The dose of PR was adjusted until the resting heart rate had been reduced by 25% or was less than 55 bpm. In the PR plus ISMN group, after PR was titrated to the same target, the dose of ISMN was increased up to 20 mg orally twice a day. Variceal pressure was measured using a noninvasive endoscopic balloon technique at the end of the 6-mo treatment period.
  
  
  RESULTS
  In 40 patients (20 in the PR group and 20 in the PR plus ISMN group), variceal pressure was measured before treatment and at the end of the 6-mo treatment period. PR or PR plus ISMN treatment caused a significant reduction in variceal pressure (PR group: from 24.15 ± 6.05 mmHg to 22.68 ± 5.70 mmHg, P = 0.001; PR plus ISMN group: from 25.69 ± 5.26 mmHg to 20.48 ± 5.43 mmHg; P < 0.001). The percentage decrease in variceal pressure was significant after PR plus ISMN compared with that after PR alone (15.93% ± 8.37% vs 6.05% ± 3.67%, P = 0.01). One patient in the PR plus ISMN group and two patients in the PR group had variceal bleeding during follow-up. There were no significant differences between the two groups regarding the incidence of variceal bleeding. In the PR plus ISMN group, three patients had headache and hypotension. The headache was mild and transient and promptly disappeared after continuation of the relevant drug in two patients. Only one patient withdrew from the trial due to severe and lasting headache after taking ISMN. No side effects occurred in the PR group.
  
  
  CONCLUSIONS
  PR plus ISMN therapy may be an alternative treatment for patients with schistosomiasis who have a high risk of bleeding.
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.
authors.forename: De-Run
authors.initials: DR
authors.lastname: Kong
authors.forename: Chao
authors.initials: C
authors.lastname: Ma
authors.forename: Min
authors.initials: M
authors.lastname: Wang
authors.forename: Jing-Guang
authors.initials: JG
authors.lastname: Wang
authors.forename: Chen
authors.initials: C
authors.lastname: Chen
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.forename: Jia-Hu
authors.initials: JH
authors.lastname: Hao
authors.forename: Pan
authors.initials: P
authors.lastname: Li
authors.forename: Jian-Ming
authors.initials: JM
authors.lastname: Xu
mesh_terms: D000328:Adult; D002681:China; D004359:Drug Therapy, Combination; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007548:Isosorbide Dinitrate / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000187:drug effects*; D011433:Propranolol / Q000009:adverse effects / Q000627:therapeutic use*; D012552:Schistosomiasis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D011433:Propranolol; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate
keywords: Bleeding; Esophageal varices; Isosorbide-5-mononitrate; Portal hypertension; Propranolol; Schistosomiasis; Variceal pressure