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Management of digestive bleeding related to portal hypertension in cirrhotic patients:A French multicenter cross-sectional practice survey

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World journal of Gastroenterology 2006年第48期12卷 7810-7814页

作者： Pierre Ingrand jérme gournay Pierre Bernard Frédéric Oberti Brigitte Bernard-Chabert Arnault Pauwels Philippe renard Eric Bartoli jean-Franois Cadranel jean-Claude Barbare Isabelle Ingrand Michel Beauchant Clinical research Center Poitiers University France Hepato-Gastroenterology Centre Hospitalier Universitaire Nantes France Hepato-Gastroenterology Centre Hospitalier Universitaire Saint-André Bordeaux France Hepato-Gastroenterology Centre Hospitalier Universitaire Angers France Hepato-Gastroenterology Centre Hospitalier Universitaire Reims France Hepato-Gastroenterology Centre Hospitalier Gonesse France Hepato-Gastroenterology Centre Hospitalier Argenteuil France Hepato-Gastroenterology Centre Hospitalier Universitaire Amiens France Hepato-Gastroenterology Centre Hospitalier Creil France Hepato-Gastroenterology Centre Hospitalier Compiègne France Hepato-Gastroenterology Centre Hospitalier Universitaire Poitiers France

AIM: To investigate the conformity of management practices of gastrointestinal hemorrhage in cirrhotic patients with relevant guidelines. meTHODS: A questionnaire on the management of digestive bleeding was completed for all consecutive cirrhotic patients admitted to 31 French hospitals. rESULTS: One hundred and twenty-six bleeding events were recorded. It was the first bleeding episode in 79 patients (63%), of whom 40 (51%) had a prior diagnosis of cirrhosis and 25 (32%) had previously undergone an endoscopy. The bleeding episode was a recurrence in 46 patients (37%). The median time between onset and admission was 4 h, but exceeded 12 h in 42% of cases. There was an agreement between centers forearly vasoactive drug administration (87% of cases), association with ligation (42%) more often than sclerosis (21%) at initial endoscopy, and antibiotic prophylaxis (64%). By contrast, prescription of beta-blockade alone or in combination (0 to 100%, P = 0.003) for secondary prophylaxis and lactulose (26% to 86%, P = 0.04), differed among centers. CONCLUSION: In French hospitals, management of bleeding related to portal hypertension in cirrhotic patients is generally in keeping with the consensus. Broad variability still remains concerning beta-blockade use for secondary prophylaxis. Screening for esophageal varices, the use of antibiotic prophylaxis and patients information need to be improved.

关键词： Digestive bleeding Portal hypertension Cirrhosis Evaluation studies

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