Effectiveness of beta blockers in primary prophylaxis of variceal bleeding in children with portal hypertension.
ABSTRACT 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.
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).
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.
Beta blockers are effective in preventing variceal bleed in children with portal hypertension. Long-term efficacy of carvedilol and propranolol was similar.
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ABSTRACT: Portal vein thrombosis (PVT) is a common cause of portal hypertension (PH) in children. Predisposing conditions for PVT are obscure in more than half of the cases. Variceal bleeding and splenomegaly are the most frequent initial manifestations. Radiologic imaging studies are the mainstay for diagnosis. Treatment includes pharmacologic, endoscopic and surgical modalities. Beta-adrenergic blockers are not routinely used in children due to unproven efficacy and significant side effects. Endoscopic methods, such as sclerotherapy and endoscopic variceal ligation (EVL), are highly effective in the treatment of acute variceal bleeding and eradication of varices. EVL is the treatment of choice due to minimal complications and the need for few endoscopic sessions. EVL facilitates portal decompression either by the formation of collateral vessels or by surgical portosystemic shunting, when vessels grow to the proper diameter for anastomosis. Surgical portosystemic shunts are reserved for refractory cases due to significant complications and technical difficulties. Transjugular portosystemic shunts have an emerging role in the management of PH due to PVT. PVT may occur in the post-transplant setting, but optimal management is not defined yet.Journal of pediatric gastroenterology and nutrition 06/2013; DOI:10.1097/MPG.0b013e3182a1cd7f