الفهرس 
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Abstract
Low-dose carvedilol (12.5 mg (is an extremely potent portal hypotensive pharmacological agent. This efficacy in reduction of portal hypotension variceal bleeding suggests that carvedilol has a role in the management of clinically significant portal hypertension. This study aimed at evaluation of the role of carvedilol in prevention of first variceal bleeding in patients with liver cirrhosis and to compare its effect with that of VBL and propranolol. Seventy five patients were selected with liver cirrhosis and endoscopically proven esophageal varices (grade II or larger in size with or without variceal red color signs), that have not bled yet after exclusion of patients with contraindications to b-blockers, allergy to the drugs , serum creatinine greater than 2 mg/dL, history of haematemesis and/or melena , history of sclerotherapy or band ligation, history of beta blockers, nitrates intake or angiotensin converting enzyme inhibitor, hepatoma portal or hepatic vein thrombosis ,large-volume or tense ascites, presence of moderate or large gastric or duodenal varices , severe erosive esophagitis, active duodenal or gastric ulceration, or UGT tumor or severe portal hypertensive gastropathy with spontaneous or contact bleeding. They were randomly allocated into 3 equal treatment groups; Group I twenty five patients underwent prophylactic endoscopic variceal band ligation (VBL). It was repeated every 2 to 4 weeks until eradication of esophageal varices either to grade I or complete obliteration. Group II twenty five patients took carvedilol .It was started at a dosage of single 6.25 mg daily at the morning. The dosage of carvedilol was stepwise increased after 1-2 weeks to a target dose of 12.5 mg per day while heart rate is more than 55 beat per minute and systolic pressure is greater than 85 mm Hg. Group III twenty five patients took propranolol. It was started at a dosage of 20 mg twice daily and the dosage was stepwise increased every 1-2 weeks by 20-40mg as tolerated until the resting heart rate was reduced by 25% from base line or was approximately 55beat per minute while systolic blood pressure was greater than 85 mm Hg. All the patients in the three treatment groups were subjected to full history taking, clinical examination, completer blood picture, liver and kidney function test, Child Pugh classification, abdominal ultrasonography, colored doppler portal vein, upper GIT endoscopy at time of first examination and at 6&12 months. Assessment of 1st variceal bleeding was done in the three treatment groups during the follow up period. There were no statistically significant differences among the three treatment groups regarding demographic and base line Clinical data, laboratory, Child Pugh class, ultrasonographic data, portal vein CI and endoscopic findings.