Comparative study of primary and secondary prevention of bleeding oesophgeal varices

Abstract EN

Bleeding esophageal varices is one of the major health problems in Egypt which results in great morbidity and mortality The aim of this study was to valuate the effect of propranolol on primary prophylaxis and to compare the effect of propranolol, sclerotherapy and the combination of both on secondary prophylaxis.

This study included 302 patients- with liver cirrhosis and esophageal varices who were classified into five groups, two groups of primary prophylaxis and three groups of secondary prophylaxis.

The first group was under propranolol therapy (88 patients) and the second group was the control group(62 patients), with mean age 49 years and the mean follow-up period *as 2.97 ±1.88 years for the firmer and 2.35±J.

I years for the latter.

The frequency of bleeding was significantly less in the propramdol group than the control group (26.l% versus 48.

4% )P< 0.05.

the percentage of bleeder who needed blood transfusion was more in the propranolol group (82.6'% ) than in the control -group (70% with no significant different but the amount of transfused Mood was significantly higher in propranolol group than in the control group (305= 1.05 versus I.68 ± 0.72 units) p< 0.001.

in secondary prophylaxis [propranolol alone (52 patients) sclerotherapy alone(48 patients) and combined (52].

the mean duration of therapy was 2.73 + 1,34.

2.42+ 079 and2.83+ 1.46 years respectively.

The frequency of rebleedmg was less in the combination therapy group (23.07%) than the propranolol (40.4%) and the sclerotherapy group (50%) with no significant difference The amount of transfused blood units was significantly less m the combination therapy group than the propranolol group in the first and second attack, P < 0 003 and P < 0.04 respectively, but with no significant difference in comparison with sclerotherapy group We conclude that propranolol is an effective treatment in primary prophylaxis as it decreases rate of bleeding albeit increasing the nerd for and the amount of blood transfusion also , this study supported the long-term use of propriwiolol plus endoscopic sclerotherapy for secondary prevention of bleeding esophageal varices .