Preview

Russian Journal of Gastroenterology, Hepatology, Coloproctology

Advanced search

Principles of portal hypertension treatment at patients with liver cirrhosis

Abstract

The aim of review. To describe modern principles of portal hypertension treatment in patients with liver cirrhosis (LC).

Original positions. One of the most significant LC complications is portal hypertension - acute bleeding from varicose veins (VV) of the esophagus and the stomach, ascites, hepatorenal syndrome. VV bleeding is a critical state at which 15–20% of patients die within subsequent 6 wks. Patients with acute episode of bleeding require treatment by vasoconstrictors, antibiotics in combination to endoscopic methods of treatment. For bleeding prophylaxis β-adrenoblockers, endoscopic procedures are used. Hepatorenal syndrome is associated to infections most often. Without treatment or liver transplantation patients with hepatorenal syndrome of the 1st type live for no more than 2 wks. Vasoconstrictors in combination to albumin are drugs of choice for these patients. Prophylaxis requires careful monitoring for other complications of cirrhosis, compensation of liver function.

Conclusion. Patients with liver cirrhosis and portal hypertension are severe patients. Life prognosis most often is determined by infections and associating renal failure (hepatorenal syndrome), esophageal varices bleedings. As the major part of these states peripheral vasodilation, prescription of vasoconstrictors (first of all — terlipressin) is pathogenically justified and results in arrest of acute bleedings from esophageal VV, and in functional recovery of kidneys at renal failure.

About the Authors

Ye. A. Fedosina
ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздравсоцразвития РФ
Russian Federation


M. V. Mayevskaya
ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздравсоцразвития РФ
Russian Federation


V. T. Ivashkin
ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздравсоцразвития РФ
Russian Federation


References

1. Болезни печени и желчевыводящих путей: Руководство для врачей / Под ред. В.Т. Ивашкина. – 2-е изд., испр. и доп. – М.: Изд. Дом «М-Вести», 2005. – С. 152–164.

2. Лечение осложнений цирроза печени: Методические рекомендации для врачей / Под ред. В.Т. Ивашкина, М.В. Маевской, Е.А. Федосьиной. – М.: Литтерра, 2011. – 59 с.

3. Ascites and renal dysfunction in liver disease: pathogenesis, diagnosis, and treatment / eds. Arroyo V., Ginеs P., Rodеs J., Schrier R.W. – Malden–Mass: Blackwell Science, 2005.

4. Fabrizi F., Dixit V., Martin P. Meta-analysis: terlipressin therapy for the hepatorenal syndrome // Aliment. Pharmacol. Ther. – 2006. – Vol. 24, N 6. – Р. 935–944.

5. Franchis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension // J. Hepatol. – 2010. – Vol. 53. – P. 762–768.

6. Garcia-Tsao G. Bacterial infections in cirrhosis: treatment and prophylaxis // J. Hepatol. – 2005. – Vol. 42. – P. 85–92.

7. Garcia-Tsao G., Bosch J. Management of varices and variceal hemorrhage in cirrhosis // N. Engl. J. Med. – 2010. – Vol. 362. – P. 823–832.

8. Gines Р., Cardenas А., Arroyo V., Rodes J. Management of cirrhosis and ascites // N. Engl. J. Med. – 2004. – Vol. 350. – P. 1646–1654

9. Gines Р., Schrier R. Renal failure in cirrhosis // N. Engl. J. Med. – 2009. – Vol. 361. – P. 1279–1290.

10. Moore K.P., Wong F., Gines P. et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club // Hepatology. – 2003. – Vol. 38. – P. 238–266.

11. Sagi S.V., Mittal S., Kasturi K.S., Sood G.K. Terlipressin therapy for reversal of type 1 hepatorenal syndrome: a meta-analysis of randomized controlled trials // J. Gastroenterol. Hepatol. – 2010. – Vol. 25, N 5. – Р. 880–885.


Review

For citations:


Fedosina Ye.A., Mayevskaya M.V., Ivashkin V.T. Principles of portal hypertension treatment at patients with liver cirrhosis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2012;22(5):46-55. (In Russ.)

Views: 72


ISSN 1382-4376 (Print)
ISSN 2658-6673 (Online)