Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russia.
Department of Pathological Anatomy and Forensic Medicine, South Ural State Medical University, Chelyabinsk, Russia.
J Evid Based Med. 2020 Nov;13(4):313-324. doi: 10.1111/jebm.12407. Epub 2020 Oct 9.
All patients with liver cirrhosis and portal hypertension should be stratified by risk groups to individualize different therapeutic strategies to increase the effectiveness of treatment. In this regard, the development of primary prophylaxis of variceal bleeding and its management according to the severity of portal hypertension may be promising. This paper is to describe the modern principles of primary prophylaxis of esophageal variceal bleeding in patients with liver cirrhosis. The PubMed and EMbase databases, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews were used to search for relevant publications from 1999 to 2019. The results suggested that depending on the severity of portal hypertension, patients with cirrhosis should be divided into those who need preprimary prophylaxis, which aims to prevent the formation of esophageal varices, and those who require measures that aim to prevent esophageal variceal bleeding. In subclinical portal hypertension, therapy should be etiological and pathogenetic. Cirrhosis with clinically significant portal hypertension should receive nonselective β-blockers if they have small esophageal varices and risk factors for variceal bleeding. Nonselective β-blockers are the first-line drugs for the primary prevention of bleeding from medium to large-sized esophageal varices. Endoscopic band ligation is indicated for the patients who are intolerant to nonselective β-blockers or in the case of contraindications to pharmacological therapy. In summary, the stratification of cirrhotic patients by the severity of portal hypertension and an individual approach to the choice of treatment may increase the effectiveness of therapy as well as improve survival rate of these patients.
所有肝硬化和门静脉高压症患者都应按风险组分层，以制定个体化的治疗策略，提高治疗效果。在这方面，原发性预防静脉曲张出血及其根据门静脉高压严重程度进行管理的发展可能是有希望的。本文旨在描述肝硬化患者食管静脉曲张出血一级预防的现代原则。检索了 1999 年至 2019 年的相关文献，包括 PubMed 和 EMbase 数据库、Web of Science、Google Scholar 和 Cochrane 系统评价数据库。结果表明，根据门静脉高压的严重程度，应将肝硬化患者分为需要预防性预防的患者，其目的是预防食管静脉曲张的形成，以及需要采取旨在预防食管静脉曲张出血的措施的患者。在亚临床门静脉高压症中，治疗应针对病因和发病机制。对于有小食管静脉曲张和静脉曲张出血危险因素的临床显著门静脉高压症患者，如果能够耐受非选择性β受体阻滞剂，应给予非选择性β受体阻滞剂。非选择性β受体阻滞剂是预防中至大型食管静脉曲张出血的一线药物。对于不能耐受非选择性β受体阻滞剂或存在药物治疗禁忌证的患者，应采用内镜套扎治疗。总之，根据门静脉高压的严重程度对肝硬化患者进行分层，并对治疗方法进行个体化选择，可能会提高治疗效果，并提高这些患者的生存率。
