2- Day vs. 5- Day Terlipressin and Ceftriaxone in the Control Acute Gastroesophageal Variceal Hemorrhage

Launched by E-DA HOSPITAL · Aug 13, 2019

Keywords

ClinConnect Summary

Acute gastro-esophageal variceal hemorrhage is a dreadful complication of portal hypertension. Meta-analysis showed that the combination of vasoconstrictor and endoscopic therapy is superior to endoscopic therapy or vasoconstrictor alone in the control of acute esophageal variceal hemorrhage. Bacterial infections are frequently encountered in cirrhotic patients presenting with acute upper gastrointestinal bleeding. The association of bacterial infections to variceal bleeding may increase the occurrence of variceal rebleeding and mortality. A study has shown that antibiotic prophylaxis in pa...

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Eligibility criteria

• Inclusion Criteria:
• • 1. Patients were diagnosed to have cirrhosis based on history, physical examinations, image studies or histological examination..
• • 2. Age ranges between 20-80 y/o.
• • 3. Patients presenting with hematemesis and /or melena within 24 hours of inclusion.
• • 4. Esophageal variceal bleeding is controlled by esophageal variceal ligation (EVL). Gastric variceal bleeding is controlled by endoscopic glue ( histoacryl) injection.
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• Exclusion Criteria:
• • 1. Uncertain of bleeding source.
• • 2. Failure in endoscopic therapy.
• • 3. Had variceal bleeding or peptic ulcer bleeding in recent one month
• • 4. has evidence of bacterial infections or possible infection at entry ( such as fever \> 37.5。 C, white blood cells\> 10000/cumm, urine leukocytes \>10/ field, pneumonic patches on chest x-ray, ascitic polymorphonuclear cells \> 250/cumm, cellulitis or other focal infections).
• • 2) ever received antibiotics within 4 weeks before index upper gastrointestinal bleeding.
• • 3) presence of cardiopulmonary embarrassment 4) association with uremia and receiving hemodialysis or peritoneal dialysis. 5) presence of deep jaundice (serum bilirubin \> 10 mg/dl), hepatic encephalopathy stage III or IV, massive or refractory ascites 6) presence of chronic kidney disease ( serum creatinine \> 2 mg/dl) or hepatorenal syndrome 7) Had history of cerebrovascular accident, coronary artery disease, complete AV block or peripheral vascular disorder 6) association with human immunodeficiency virus (HIV) infection, advanced carcinoma or hepatocellular carcinoma Barcelona Club Liver Cancer (BCLC) class C or D.
• • 7) allergy to terlipressin, cephalosporins or penicillin 8) pregnancy. 9) Uncooperative or decline to be enrolled
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