الفهرس 
Introduction and aim of this workOnly 14 pages are availabe for public view
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Abstract
Portal hypertension is a major complication of cirrhosis. Its main clinical consequence, bleeding from ruptured gastroesophageal varices, is one of the leading causes of death in patients with liver cirrhosis. Endoscopic injection sclerotherapy is widely used for treatment of variceal bleeding and prevention of rebleeding. However, sclerotherapy treated patients may experience a rebleeding rate as high as 50% before complete variceal obliteration and may result in significant elevation in portal vein kinetic pressure. Aim of work: The aim of this prospective randomized study is to evaluate the safety and efficacy of valsartan when added to sclerotherapy for prevention of rebleeding compared to sclerotherapy alone. Also, we studied the effect of valsartan on systemic and portal haemodynamics. Patients and methods: All patients were subjected to thorough history taking, full clinical examination, liver and kidney function tests, complete blood picture, hepatitis B and C markers, IHA for bilharzial infection, abdominal ultrasonography and HVPG by hepatic vein catheterization. Randomization was carried out after bleeding has been controlled and the patients were divided into 2 groups: Group I: treated by regular endoscopic sclerotherapy at 2 weeks interval plus valsartan 80 mg once daily orally for 8 weeks, it included 30 patients, 26 males and 4 females with mean age of 47 <U+F0B1> 8.4 years. Group II: treated by endoscopic sclerotherapy alone at 2 weeks interval and for 8 weeks, it included 30 cirrhotic patients, 27 males and 3 females with mean age of 46 <U+F0B1> 4.3 years. Results: Variceal obliteration occurred in 20 patients (66.7%) in group I and 2 patients (6.7%) in group II (P < 0.001). Variceal rebleeding in occurred 2 patients (6.7%) in group I and 12 patients (40%) in group II (P = 0.005). Significant decrease in WHVP in group I patients and insignificant change in WHPV in group II patients. Significant decrease in HVPG in group I patients. On the other hand, group II patients showed insignificant increase in HVPG. No recorded deaths in both groups during period of follow up. Conclusions: Combination of endoscopic sclerotherapy and valsartan is superior to sclerotherapy alone in inducing variceal obliteration and decreasing variceal rebleeding episodes in cirrhotic patients Child class A and B with ruptured oesophageal varices. Hepatic venous pressure gradient measurement is safe, accurate and very efficient for follow up of pharmacotherapy in portal hypertension and is recommended for the assessment of the efficacy of any pharmacological treatment in portal hypertension as recommended by Baveno III consensus conference.