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Combination Therapy with Propranolol and Cephalanoplos Segetum Against First Variceal Hemorrhage in Patients with Cirrhosis

Ik-Sun Kim, Suk-Hui Kim, Hyon U


Background: Primary prophylaxis aims to prevent variceal hemorrhage in patients with esophageal varices who do not have a history of hemorrhage. The use of nonselective beta blockers is the first option for primary prophylaxis to prevent variceal bleeding in patients with the cirrhosis. Application of non-selective beta blocker has various kinds of merits, but patient's endurance to beta blocker becomes a problem and it does not prevent primary variceal bleeding perfectly. To improve the preventive effect of the beta blockers on the upper gastrointestinal bleeding we used beta blockers in combination with the Cephalanoplos segetum which has strong anti-hemorrhagic and treatment action on liver and biliary tract system and examined its efficacy in the treatment. Method: In combination therapy group and single therapy group accumulative non-bleeding rate and improved formation and red coloure sign of gastroesophageal varices after treatment was compared. Result: After 1 year of Combination therapy of propranolol with Cephalanoplos segetum, the first variceal bleeding was significantly lowered and better effect than single treatment (bleeding rate was 6.8% and 11.1% respectively while accumulative non-bleeding rate was 91.5% in combination therapy and 81.3% in control group). Also, the formation and red coloure sign of gastroesophageal varices have been significantly improved both in combination therapy group and single therapy group after treatment, but this effect was more obvious in combination therapy group. (P<0.01). Conclusion: This research result shows that prevention effect of variceal hemorrhage was higher in Combination therapy groups.


Propranolol, Cephalanoplos segetum, variceal hemorrhage, gastroesophageal, therapy

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North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med 1988; 319:983-989.

Garcia-Tsao G, Sanyal AJ, Grace ND, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46(3):922-938.

Groszmann RJ, Garcia-Tsao G, Bosch J, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005; 353(21):2254-61.

Jaime Bosch, Tilman Sauerbruch. Esophageal varices: Stage-dependent treatment algorithm. J. Hepatol. 2016; 64(3):746–748.

de Franchis R, Baveno V Faculty. Revising consensus in portal hypertension report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53(4):762-8.

Lebrec D, Hillon P, Muoz C, et al. The effect of propranolol on portal hypertension in patients with cirrhosis: a hemodynamic study. Hepatology 1982; 2(5):523-7.

Vlachogiannakos J, Goulis J, Patch D, Burroughs AK. Review article: primary prophylaxis for portal hypertensive bleeding in cirrhosis. Aliment Pharmacol Ther 2000; 14(7):851-60.

Hayes PC, Davis JM, Lewis JA, Bouchier IA. Meta-analysis of value of propranolol in prevention of variceal haemorrhage. Lancet 1990; 336(8708):153-6.

Pugh RN, Murray-Lyon IM, Dawson JL, et. al. Transection of the oesophagus for bleeding oesophageal varices. Br. J. Surg. 1973 ;60(8):646-9.

Child CG, Turcotte JG. The Liver and Portal Hypertension. Philadelphia, WB Saunders Co .1964:51(11):iv.

Trey C, Burns DG, Saunders SJ. Treatment of hepatic coma by exchange blood transfusion. NEJM. 1966; 274(9):473-81.

Beppu K, Inokuchi K, Koyanagi N, et al. Prediction of variceal hemorrhage by esophageal endoscopy. Gastrointest Endosc 1981; 27(4):213-8.

Lebrec D, Nouel O, Corbic M, Benhamou JP. Propranolol – a medical treatment for portal hypertension? Lancet 1980; 2(8187):180–182.

Garcia-Tsao G, Bosch J. Varices and variceal hemorrhage in cirrhosis: a new view of an old problem. Clin Gastroenterol Hepatol 2015; 13(12):2109–2117.

Abraldes JG, Tarantino I, Turnes J, Garcia-Pagan JC, Rodes J, Bosch J.Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology 2003; 37(4):902–908.

D’Amico G, Garcia-Pagan JC, Luca A, Bosch J. HVPG reduction and prevention of variceal bleeding in cirrhosis. A systematic review. Gastroenterology 2006; 131(5):1611–1624.

Lebrec D, Poynard T, Bernuau J, et al: Randomized controlled study of propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: A final report.Hepatology 1984; 4(3):355-358.

Andreani T, Poupon RE, Balkau B, et al: Preventive therapy of first gastrointestinal bleeding in patients with cirrhosis: Results of a controlled trial comparing propranolol, endoscopic sclerotherapy and placebo. Hepatology 1990; 12(6):1413-1419.

Lebrec D, Poynard T, Capron JP, et al. Nadolol for prophylaxis of gastrointestinal bleeding in patients with cirrhosis. A randomized trial. J Hepatol 1988; 7(1):118-25.

Idéo G, Bellati G, Fesce E, Grimoldi D. Nadolol can prevent the first gastrointestinal bleeding in cirrhotics: a prospective, randomized study. Hepatology 1988; 8(1):6-9.

Pascal JP, Cales P. Propranolol in the prevention of first upper gastrointestinal tract hemorrhage in patients with cirrhosis of the liver and esophageal varices. N Engl J Med 1987; 317(14):856-61.

Propranolol prevents first gastrointestinal bleeding in non-ascitic cirrhotic patients. Final report of a multicenter randomized trial. The Italian Multicenter Project for Propranolol in Prevention of Bleeding. J Hepatol. 1989(1); 9:75-83.

Prophylaxis of first hemorrhage from esophageal varices by sclerotherapy, propranolol or both in cirrhotic patients: a randomized multicenter trial. The PROVA Study Group. Hepatology 1991; 14:1016.

Sanyal AJ, Shiffman ML. The pharmacologic treatment of portal hypertension. Annu Rev Gastrointest Pharmacol 1996; 14:242.

Triantos CK, Burroughs AK. Prevention of the development of varices and first portal hypertensive bleeding episode. Best Pract Res Clin Gastroenterol 2007; 21(1):31-42.

Inokuchi K, Cooperative Study Group of Portal Hypertension of Japan: Improved survival after prophylactic portal nondecompression surgery for esophageal varices: A randomized clinical trial. Hepatology 1990; 12(1): 1-6,

Merkel C, Marin R, Angeli P, et al. A placebo-controlled clinical trial of nadolol in the prophylaxis of growth of small esophageal varices in cirrhosis. Gastroenterology 2004; 127(2):476-84.


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