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Statins and variceal bleeding

Knut Stokkeland, Jonas Höijer, Matteo Bottai, Karin Söderberg-Löfdal, Annika Bergquist
BACKGROUND & AIMS: There is increasing evidence that statins can benefit patients with chronic liver diseases, but their effects have not been studied in patients with primary sclerosing cholangitis (PSC). We performed a nationwide study in Sweden to determine the effects of exposure to drugs, including statins, in patients with PSC. METHODS: We studied a population-based cohort of patients in Sweden with PSC and concomitant ulcerative colitis or Crohn´s disease from 2005 through 2014 (n=2914), followed through 2016...
November 15, 2018: Clinical Gastroenterology and Hepatology
Tilman Sauerbruch, Florence Wong
BACKGROUND: The development of cirrhosis with resultant portal hypertension can lead to oesophageal varices at a rate of 7% per annum. Bleeding from varices happens when the portal pressure is ≥12 mm Hg and can threaten life. SUMMARY: Eliminating the aetiology of cirrhosis is a pivotal step to prevent the formation of varices. In patients with established varices, primary prophylaxis with non-selective beta blockers (NSBB) may slow down the progression of varices and prevent the first variceal bleed...
September 13, 2018: Digestion
Samarth S Patel, Luis A Guzman, Fei-Pi Lin, Taylor Pence, Trevor Reichman, Binu John, Francesco S Celi, Erika Liptrap, Chandra Bhati, Mohammad S Siddiqui
Coronary artery disease (CAD) assessment is a vital part of liver transplantation (LT) evaluation, as it allows for identification and medical optimization prior to transplantation. Although aspirin and statins are standard of care for CAD, they are not universally used in cirrhosis due to concerns about adverse events. Per protocol, coronary angiography was performed as part of the LT evaluation in all patients over the age of 50 years or with CAD risk factors, even if they were younger than 50. Optimal CAD medical management was defined as the use of both statin and aspirin, unless a contraindication was documented...
July 2018: Liver Transplantation
Anna Baiges, Virginia Hernández-Gea, Jaime Bosch
BACKGROUND: Variceal bleeding is a major complication of portal hypertension, which is associated with significant mortality. Moreover, patients surviving a variceal bleeding episode have very high risk of rebleeding, which is associated with mortality as high as that of the first bleed. Because of this, prevention of bleeding from gastroesophageal varices has been one of the main therapeutic goals since the advent of the first effective therapies for portal hypertension. AIM: This review deals with the present day state-of-the-art pharmacological prevention of variceal bleeding in primary and secondary prophylaxis...
February 2018: Hepatology International
Ming-Chao Tsai, Chien-Hung Chen, Tsung-Hui Hu, Sheng-Nan Lu, Chuan-Mo Lee, Jing-Houng Wang, Chao-Hung Hung
BACKGROUND/PURPOSE: This study aimed to evaluate the outcomes of chronic hepatitis B patients with cirrhosis who received long-term nucleos(t)ide analog therapy. METHODS: A total of 546 consecutive cirrhotic patients treated with entecavir (n = 359), telbivudine (n = 104), or tenofovir (n = 83) for chronic hepatitis B were enrolled. The incidence of hepatocellular carcinoma (HCC) and overall survival were evaluated. RESULTS: During a median follow-up of 39 months, 56 (10...
July 2017: Journal of the Formosan Medical Association, Taiwan Yi Zhi
Martin Janicko, Sylvia Drazilova, Daniel Pella, Jan Fedacko, Peter Jarcuska
Statins are a class of molecules that inhibit HMG CoA reductase. They are usually prescribed as a lipid lowering medication. However, there is accumulating evidence that statins have multiple secondary effects both related and unrelated to their lipid-lowering effect. This narrative review of the literature aims to provide the reader with information from clinical studies related to the effect of statin and statins' potential use in patients with liver diseases. In patients with advanced liver disease due to any etiology, statins exhibit an antifibrotic effect possibly through the prevention of hepatic sinusoidal microthrombosis...
July 21, 2016: World Journal of Gastroenterology: WJG
Javier Fernández, Puneeta Tandon, Jose Mensa, Guadalupe Garcia-Tsao
UNLABELLED: Patients with cirrhosis, particularly those with decompensated cirrhosis, are at increased risk of bacterial infections that may further precipitate other liver decompensations including acute-on-chronic liver failure. Infections constitute the main cause of death in patients with advanced cirrhosis, and strategies to prevent them are essential. The main current strategy is the use of prophylactic antibiotics targeted at specific subpopulations at high risk of infection: prior episode of spontaneous bacterial peritonitis, upper gastrointestinal bleeding, and low-protein ascites with associated poor liver function...
June 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Priscila Pollo-Flores, Mônica Soldan, Ubiratan Cassano Santos, Danielle Gobbi Kunz, Denise Espindola Mattos, Alexandre Cerqueira da Silva, Roberta Cabral Marchiori, Guilherme Ferreira da Motta Rezende
BACKGROUND: Pleiotropic effects of statins decrease intrahepatic resistance and portal hypertension. AIM: We evaluated the effects of simvastatin on hepatic venous pressure gradient (HVPG) and azygos vein blood flow in cirrhotic patients. METHODS: A 3-month prospective, randomized, triple-blind trial with simvastatin (40 mg/day) vs. placebo was conducted in patients with cirrhotic portal hypertension. HVPG and azygos blood flow, measured by colour Doppler endoscopic ultrasound, were assessed before and after treatment...
November 2015: Digestive and Liver Disease
Jordi Gracia-Sancho, Raquel Maeso-Díaz, Jaime Bosch
Portal hypertension is a common complication of chronic liver disease. Its relevance comes from the fact that it determines most complications leading to death or liver transplantation in patients with cirrhosis of the liver: bleeding from esophageal or gastric varices, ascites and renal dysfunction, sepsis and hepatic encephalopathy. Portal hypertension results from increased resistance to portal blood flow through the cirrhotic liver. This is caused by two mechanisms: (1) distortion of the liver vascular architecture due to the liver disease causing structural abnormalities (nodule formation, remodeling of liver sinusoids, fibrosis, angiogenesis and vascular occlusion), and (2) increased hepatic vascular tone due to sinusoidal endothelial dysfunction, which results in a defective production of endogenous vasodilators, mainly nitric oxide (NO), and increased production of vasoconstrictors (thromboxane A2, cysteinyl leukotrienes, angiotensin II, endothelins and an activated adrenergic system)...
2015: Digestive Diseases
Hui-Chun Huang, Sun-Sang Wang, Jing-Yi Lee, Yi-Chou Chen, Fa-Yauh Lee, Han-Chieh Lin, Ching-Chih Chang, Shou-Dong Lee
BACKGROUND AND AIM: Portal-systemic collateral vascular resistance and vasoconstrictor responsiveness are crucial in portal hypertension and variceal bleeding control. Statins enhance vasodilators production, but their influence on collaterals is unknown. This study aimed to survey the effect of simvastatin on collaterals. METHODS: Partially portal vein-ligated rats received oral simvastatin (20 mg/kg/day) or distilled water from -2 to +7 day of ligation. After hemodynamic measurements on the eighth postoperative day, baseline perfusion pressure (i...
August 2010: Journal of Gastroenterology and Hepatology
Wim Laleman, Lien Landeghem, Alexander Wilmer, Johan Fevery, Frederik Nevens
Portal hypertension (PHT) is responsible for the more severe and often lethal complications of cirrhosis such as bleeding oesophageal varices, ascites, renal dysfunction and hepatic encephalopathy. Because of the combined impact of these complications, PHT remains the most important cause of morbidity and mortality in patients with cirrhosis. Over the years, it has become clear that a decrease in portal pressure is not only protective against the risk of variceal (re)bleeding but is also associated with a lower long-term risk of developing complications and an improved long-term survival...
December 2005: Liver International: Official Journal of the International Association for the Study of the Liver
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