Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sixty-six patients with portal hypertension and esophageal varices due to liver cirrhosis were randomized to receive either 5% ethanolamine oleate (EO) or 5% EO plus 1% polidocanol (EOP) as a sclerosant for endoscopic injection sclerotherapy (EIS). The two groups were well matched with regard to age, sex and the severity of liver disease. In no patient in the two groups was there any major complication, such as esophageal perforation or esophageal bleeding. Eradication of esophageal varices was attained with an average of 4.7 and 4.3 sessions of endoscopic injection sclerotherapy in the ethanolamine oleate and polidocanol groups, respectively. Data on one patient in the ethanolamine oleate group had to be excluded because he left the hospital after 2 sessions of endoscopic injection sclerotherapy. Esophageal ulcers occurred earlier in the polidocanol group (after an average of 2.8 weeks) than in the ethanolamine oleate group (3.8 weeks), the difference being statistically significant (P < 0.01). The rate of occurrence of esophageal stricture requiring more than 2 sessions of bougienage was significantly (P < 0.01) higher in the polidocanol group (16/33, 48%) than in the ethanolamine oleate group (4/32, 12%). This study suggests that the two sclerosants have equal efficacy for treating patients with esophageal varices. With polidocanol there was ulceration and stricture in the distal esophagus.
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PMID:Comparative effects of 5% ethanolamine oleate versus 5% ethanolamine oleate plus 1% polidocanol for sclerosing esophageal varices. 148 69

Thirty-one children with variceal bleeding due to portal hypertension (extrahepatic obstruction 19, non-cirrhotic portal fibrosis five, and cirrhosis of liver seven patients) were treated with endoscopic sclerotherapy with absolute alcohol. Acute variceal bleeding was successfully controlled in 10 patients by emergency sclerotherapy. A 3 weekly schedule of sclerotherapy could achieve obliteration of varices in all the patients. The mean (+/- SD) number of sclerotherapy courses and the time required for variceal eradication was 4.5 +/- 1.7 and 14.4 +/- 3.9 weeks, respectively. During a mean follow-up of 23.3 +/- 11.4 months, variceal recurrence was seen in three (9.7%) patients, two with cirrhosis and one with noncirrhotic portal fibrosis. Recurrence was not seen in any patient with extrahepatic obstruction. Five (16.1%) patients had a rebleed that could be controlled with emergency sclerotherapy. Esophageal stricture developed in four (12.9%) patients and could be dilated easily in all of them. The other complications of sclerotherapy included retrosternal pain, dysphagia, and fever; these were mild and short lasting. Survival in patients with extrahepatic obstruction and noncirrhotic portal fibrosis was 100%. The only death was in a cirrhotic, who died due to terminal hepatic failure. In conclusion, endoscopic sclerotherapy can be recommended as a safe and effective treatment in children for the control of acute variceal bleeding and for variceal obliteration.
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PMID:Endoscopic sclerotherapy for varices in children. 326 87

Sixteen children (3.5-14.7 years) with portal hypertension and variceal hemorrhage were treated by direct endoscopic variceal sclerotherapy. Follow-up clinical and endoscopic evaluations have been carried out over a 1-6-year period (mean, 2.3 years). Prior to sclerotherapy, three patients had undergone unsuccessful surgical approaches, and the mean transfusional requirement from the time of the first hemorrhage was 12.3 units of blood per child per year for those with extrahepatic portal vein obstruction (n = 10) and 3.8 units for those with primary liver disease. Following sclerotherapy, transfusional requirements were significantly reduced in both groups, to 1.8 units and 2.2 units (85% and 43% reduction, respectively). Re-bleeding in four patients was due to the occurrence of gastric varices. One patient with extrahepatic portal hypertension has required subsequent shunt surgery for this complication, 5 years after sclerotherapy. Two patients have died, one with cystic fibrosis and hemorrhage from gastric varices and one from liver failure due to progressive biliary cirrhosis. Complications of sclerotherapy included transient retrosternal pain (eight occasions), esophageal ulceration with bleeding (n = 1) and esophageal stricture (n = 1). We conclude that sclerotherapy is an effective technique in obliterating esophageal varices and reducing the risk of hemorrhage in children with portal hypertension, with an acceptably low complication rate. We favor its use over more invasive surgical measures for control of acute and recurrent variceal hemorrhage, particularly for cases of extrahepatic portal hypertension in which a favorable natural history is likely.
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PMID:Evaluation of endoscopic sclerotherapy of esophageal varices in children. 348 30

One hundred one patients, 54 with cirrhosis of liver, 31 with noncirrhotic portal fibrosis (NCPF), and 16 with extrahepatic obstruction (EHO), were followed up at monthly intervals for a mean (+/- SD) period of 17.9 +/- 4.8 months after achieving total variceal eradication with endoscopic sclerotherapy. Recurrence of esophageal varices was seen in 19 (18.8%) patients, 12 with cirrhosis and seven with NCPF, within a mean (+/- SD) period of 5.7 +/- 1.6 months. No patient with EHO showed recurrence. Three (2.9%) patients rebled from the recurred varices. Mean (+/- SD) number of sclerotherapy sessions and the amount of absolute alcohol required for eradication of recurred varices were 1.6 +/- 0.8 and 3.6 +/- 1.8 ml, respectively. Dysphagia and esophageal stricture were present in 15 (14.9%) patients with nearly similar frequency in patients with cirrhosis, NCPF, and EHO. Dysphagia in four patients with stricture improved without dilatation. While there were no deaths in patients with NCPF and EHO, 11 patients with cirrhosis died. There was significant (p less than 0.01) improvement in the liver status of surviving patients with cirrhosis after variceal eradication. It can be concluded that variceal recurrence and rebleeding are not major problems after sclerotherapy. Sclerotherapy probably helps in spontaneous improvement of the liver status of surviving cirrhotics and reduces long-term morbidity and mortality of patients with NCPF and EHO.
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PMID:Follow-up of patients after variceal eradication. A comparison of patients with cirrhosis, noncirrhotic portal fibrosis, and extrahepatic obstruction. 372 86

The authors report their 2-year experience of esophageal endoscopic sclerotherapy for prevention of recurrent variceal bleeding in patients with liver cirrhosis. Sixty-three alcoholic cirrhotics underwent sclerotherapy 10 +/- 6 days (SD) after hospital admission for variceal bleeding. Varices were successfully eradicated in 43 patients (68 p. 100), with an average of 3 injection sessions, over a mean period of 5 weeks. Unsuccessful treatment was due to abbreviated course of treatment because of early rebleeding and early mortality. Early rebleeding episodes after therapy occurred in 19 patients (30 p. 100): 10 in whom the esophageal varices were eradicated, 9 in whom sclerotherapy had failed. Recurrent hemorrhage was the cause of death in 6 patients. After variceal eradication had been achieved, new varices were observed in 7 p. 100 of patients after a mean follow-up of 8 months. The risk of further variceal bleeding was 0.008 hemorrhage/patient/month. Minor complications (thoracic pain, dysphagia, esophageal ulcers, pleural effusion) occurred in 60 p. 100 of patients. An esophageal stricture developed in 13 out of the 43 successfully treated patients (30 p. 100). Major complications occurred in 5 patients and was the cause of death in 4: mediastinitis, esophageal perforation, bronchoesophageal fistulae, cardiogenic shock and aspiration pneumonitis. The survival curve, assessed by cumulative life analysis, showed a 60 p. 100 survival rate after 12 months and 56 p. 100 after 18 months. It was significantly different (p less than 0.001) between groups of cirrhosis classified according to Child-Pugh's criteria (95, 52 and 9 p. 100 at 12 months for groups A, B and C respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Evaluation of 2 years' experience with elective endoscopic sclerotherapy of hemorrhagic esophageal varices in cirrhotic patients]. 387 11

In a study designed to compare the efficacy and safety of two techniques of injection sclerotherapy, 40 patients (30 with cirrhosis and 10 with portal vein block) were randomly allocated to the sheath or free-hand technique. Although the former was associated with significantly less bleeding within the first 24 hr of injection (p less than 0.05) but more postinjection pain (p less than 0.05) and esophageal stricture, there was a trend toward earlier obliteration of varices. This was most marked over the first three courses of injection, and although frequency of rebleeding was not significantly less, none of the 11 episodes in the sheath group were fatal, compared to 5 of 15 bleeds in those injected by the free-hand technique (p less than 0.05).
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PMID:A prospective randomized study of two sclerotherapy techniques for esophageal varices. 635 48

Fifty-six patients with recent variceal haemorrhage were studied in a trial of repeated injection sclerotherapy through the flexible oesophagoscope, with a mean follow-up of 15.2 months (1-39). Twenty-five patients (45%) did not suffer further bleedings. The risk of bleeding per patient-month of follow-up decreased significantly (p less than 0.05) after starting therapy, in all groups of cirrhosis, classified according to Child's criteria. Mortality during the study period was 39% (19.6% due to recurrence of variceal bleeding). The main complications of the procedure were the development of oesophageal wall ulcerations and oesophageal stricture.
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PMID:Sclerotherapy of oesophageal varices after variceal haemorrhage. 661 May 48

Cystic fibrosis (CF), the most common lethal autosomal recessive disease in white populations, is characterized by dysfunctional chloride ion transport across epithelial surfaces. Although recurrent pulmonary infections and pulmonary insufficiency are the principal causes of morbidity and death, gastrointestinal symptoms commonly precede the pulmonary findings and may suggest the diagnosis in infants and young children. The protean gastrointestinal manifestations of CF result primarily from abnormally viscous luminal secretions within hollow viscera and the ducts of solid organs. Bowel obstruction may be present at birth due to meconium ileus or meconium plug syndrome. Complications of meconium ileus include volvulus, small bowel atresia, perforation, and meconium peritonitis with abdominal calcifications. Older children with CF may present with bowel obstruction due to distal intestinal obstruction syndrome or colonic stricture, and tenacious intestinal residue may serve as a lead point for intussusception or cause recurrent rectal prolapse. Radiologic studies often demonstrate thickened intestinal mucosal folds in older children and uncommonly show colonic pneumatosis, peptic esophageal stricture due to gastroesophageal reflux, and duodenal ulcer. Appendicitis due to inspissated secretions is uncommon. Obstruction of ducts and ductules produces exocrine pancreatic insufficiency, pancreatitis, cholestasis, cholelithiasis, and cirrhosis with portal hypertension. On imaging studies, the pancreas is commonly small and largely replaced by fat, sometimes displays calcifications, and is rarely replaced by macrocysts. Radiologic features of hepatobiliary disease include an enlarged radiolucent liver from steatosis, gallstones, a shrunken nodular liver, splenomegaly, and portosystemic collateral vessels. With the improved survival of CF patients, an increased risk for developing gastrointestinal carcinomas has been established, many occurring as early as the 3rd decade.
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PMID:Gastrointestinal manifestations of cystic fibrosis: radiologic-pathologic correlation. 883 77

Survival after childhood cancer diagnosis has remarkably improved, but emerging evidence suggests that cancer-directed therapy may have adverse gastrointestinal late effects. We aimed to comprehensively assess the frequency of gastrointestinal and liver late effects among childhood cancer survivors and compare this frequency with the general population. Our population-based cohort study included all 1-year survivors of childhood and adolescent cancer in Denmark, Finland, Iceland, Norway and Sweden diagnosed from the 1940s and 1950s. Our outcomes of interest were hospitalization rates for gastrointestinal and liver diseases, which were ascertained from national patient registries. We calculated standardized hospitalization rate ratios (RRs) and absolute excess rates comparing hospitalizations of any gastrointestinal or liver disease and for specific disease entities between survivors and the general population. The study included 31,132 survivors and 207,041 comparison subjects. The median follow-up in the hospital registries were 10 years (range: 0-42) with 23% of the survivors being followed at least to the age of 40 years. Overall, survivors had a 60% relative excess of gastrointestinal or liver diseases [RR: 1.6, 95% confidence interval (CI): 1.6-1.7], which corresponds to an absolute excess of 360 (95% CI: 330-390) hospitalizations per 100,000 person-years. Survivors of hepatic tumors, neuroblastoma and leukemia had the highest excess of gastrointestinal and liver diseases. In addition, we observed a relative excess of several specific diseases such as esophageal stricture (RR: 13; 95% CI: 9.2-20) and liver cirrhosis (RR: 2.9; 95% CI: 2.0-4.1). Our findings provide useful information about the breadth and magnitude of late complications among childhood cancer survivors and can be used for generating hypotheses about potential exposures related to these gastrointestinal and liver late effects.
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PMID:Gastrointestinal and liver disease in Adult Life After Childhood Cancer in Scandinavia: A population-based cohort study. 2719 88