الفهرس 
ContentsOnly 14 pages are availabe for public view
 |  | from | 117 |  |  |
| | | from | 117 | | |
Abstract
Approximately half of patients with cirrhosis have esophageal varices, and one-third of all patients with varices will develop variceal hemorrhage, a major cause of morbidity and mortlaity in patients with cirrhosis. Primary prophylaxis of bleeding from esoiphageal varices is defined as a therapeutic intervention that aims at the prevention of the first variceal hemorrhage. Secondary prevention is essential in patients who survive an episode of acute variceal hemorrhage as they are at high risk of recurrence. Currently, the two most widely used modalities to prevent variceal bleeding are pharmacologic (non-selective beta blockers) and endoscopic (Variceal Band Ligation, VBL). Carvedilol is non-selective β-blockers exert their effects via blockage of both β1 and β2 receptors. The β1 receptors are located in the myocardium and their blockade results in a decrease in cardiac contractility and output. On the other hand, blockde of β2 receptors located in the splanchnic (mesenteric) vascular bed results in vasoconstriction due to unopposed activity of α1 adrenergic receptors with a net effect of reduction in portal blood inflow.Carvedilo, a beta-blocker with a moderate anti-alpha-1 activity, is superior to propranolol in reducing the portal pressure and risk of variceal bleeding. The aim of this study was to compare carvedilol versus Variceal Band Ligation (VBL) in the prevention of the first variceal bleeding in children with esophageal varices at Mansoura University Children Hospital (MUCH). Our study was conducted on 44 patients with portal hypertension attending hepatic outpatient clinic in Mansoura University Children Hospital of which 25 female cases (56.8%), 19 male cases (43.2%), their age ranging from 2.5-16 years. We found that pre-treatment, there wasn’t significant difference between the two groups regarding systolic and diastolic blood pressure .while,post-treatment there was a significant difference regarding systolic and diastolic blood pressure as group I showed DROP in systolic blood pressure from 99.7 to 91 and in diastolic blood pressure from 68.4 to 61.8 but there was no difference in group II In our study, there were significant differences between the two groups regarding side effects and esophageal varices size, but there was a non-significant difference regarding bleeding. The low incidence of adverse effects in our study may be attributed to starting carvedilol in small doses and gradually increasing the dose over a period of several weeks to provide safety of the drug. All patients were hospitalized during initiation and uptitration of carvedilol.