Download Portal Hypertension III by Roberto de Franchis PDF
By Roberto de Franchis
Lawsuits of the 3rd Baveno overseas Consensus Workshop on Definitions, method and healing ideas.
The members tried to increase consensus definitions of key occasions in portal high blood pressure and variceal bleeding, diagnostic and healing concerns, and the issues of treatments for portal high blood pressure, in addition to generating up to date instructions. The lectures summarized the consensus reached within the previous workshops, addressed vital new parts of study, and analyzed the standard of trials in portal high blood pressure and different fields of hepatology.
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Sample text
If small varices were found, 15 would re-endoscope at intervals, six would use beta-blockers, and one each would either randomize in a trial or measure pressure, one had no answer. Asked their opinion as to whether published randomized trials of drugs versus banding would change their current clinical practice, 19 would continue to use drugs, one would use banding and two had no preference, one did not know. If contraindications or tolerance to drug therapy was present the treatment preferred by the panellists would be: banding ( n = 8), a controlled trial ( n = 6 ) , nitrates alone ( n = 4), no therapy ( n = 4),did not know ( n = 2).
Following discussion the consensus was: Failure of secondary prevention is a single episode of clinically significant rebleeding from portal hypertensive sources (as previously defined in Baveno 11). Table 8 Definition of failure of prevention of rebleeding (assumingdocumented portal hypertensivesources) in terms of number of episodes of clinically significantrebleeding. Responses to Baveno questionnaire. Therapy Endoscopic Drugs One clinically significantrebleed Two clinically significantrebleeds Three clinically significantrebleeds Depends on time interval 12 7 1 3 16 6 0 2 DEFINITION OF K E Y EVENTS 19 Portal pressure measurements Panellists were asked whether a single measurement (after baseline) of portal pressure was predictive of therapeutic response to medical therapy.
Greater variation in responses occurred with respect to the timing of the measurement. To date published literature has associated failure to achieve target reductions in wedged hepatic venous pressure at 3 months, with rebleeding [9]. The discussion confirmed that many patients rebleed within 3 months, as shown in a recent trial of banding versus betablockers [lo] so that earlier measurement would be indicated. A third question was asked as to whether a failure to achieve the published target reductions of > 20% from baseline HVPG or < 12 mmHg [8,9] HVPG, would lead to abandoning drug therapy providing maximally tolerated doses were being given.