Re: Portal Hypertension

Posted By HFHSM.D.-rf on April 25, 1998 at 15:56:26:

In Reply to: Portal Hypertension posted by Lee on April 14, 1998 at 23:27:10:






I recently read of a study where patients with esophageal varices were treated with Nadolol plus Isosorbide Mononitrate to prevent rebleeding.  My doctor didn't give this treatment plan much credence and she put me on Nadolol only.  Are doctors prescribing these two meds and are they effective in the prevention of rebleeding.
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Dear Lee,
Thank you for your question regarding the medical treatment of esophageal varices.  Beta blockers, of which nadolol is an example, have been shown to significantly reduce the incidence of initial variceal bleeding.  These drugs reduce cardiac output and therefore the quanity of blood in the portal circulation.  There is evidence that nitrates also reduce portal pressure, by a different mechanism than nadolol.  Nitrates act to dilate the mesenteric vessels, lowering the portal pressure.  Is the combination more effective than either drug alone? In theory, the combination should be more effective than either drug alone but there is not a lot of published material. Animal studies have shown that nitroglycerin and propranolol (another type of beta blocker) had a greater effect on portal pressure than either drug alone. A human study was published in 1993.  This study  compared the long term effects of propranolol alone with propranolol combined with a nitrate. The combination lowered the portal pressure to a greater degree than propranolol alone. The combination therapy did not adversely affect renal function although ascites did become worse.  This exacerbation of ascites limits enthusiasm for the recommendation of this therapy for all patients with esophageal varices. There is a study that showed the combination of nadolol and isosorbide nitrate was more effective than sclerotherapy.  Further work is required to confirm the long term safety and efficacy.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution in order to obtain additional information regarding therapy of esophageal varices, please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Moonka, one of our experts in the treatment of liver disease.
HFHSM.D.-rf
*keywords: liver, esophageal varices, portal hypertension
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