الفهرس 
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Abstract
SUMMARY
Portal hypertension is a common clinical problem. Hemorrhage from esophageal varices is a life-threatening event in patients with liver cirrhosis. About 40% to 80% of the patients surviving the first bleeding suffer from a recurrence of variceal bleeding within one year. This high recurrence rate substantially contributes to the mortality in patients with liver cirrhosis.
Our study aimed to evaluate the effect of propranolol on the esophageal varices reformation after being eradicated by endoscopic management either with sclerotherapy or band ligation.
In this study, 90 patients who fulfilled the inclusion criteria (after full examination and investigations) were classified into 2 groups. The first group included 47 patients (29 males and 18 females) with age range from 19 to 65 years, who received propranolol as a maximum tolerable dose, which ranged from 20 up to maximum dose of 120 mg/day (in divided doses), and 43 patients (27 males and 16 females) with age range from 35 to 65 years, who did not received propranolol as a control group.
The inclusion criteria were cirrhotic patients with eradicated varices, Child A classification.
Exclusion criteria before starting were bronchial asthma, hepatocellular carcinoma, portal vein thrombosis, diabetes mellitus, and bradycardia below 55 beat/min.
End of this study was by one of the following: recurrence of the varices, vomiting of blood (3 cases), development of HCC (5 cases), death
Patients in both groups were subjected to complete history taking and clinical examination, (Patients who received propranolol underwent baseline ECG and cardiac evaluation). Laboratory investigations, CBC, liver tests, renal tests, PT and concentration. Abdominal ultrasound and Doppler ultrasound study of the hepatic vein waveform. Follow-up endoscopy after 3 months, then 6 months, and the last session after one year.
Recurrence of the esophageal varices showed no significant difference between both groups
Time interval from the eradication of the varices till the end of the study (in months) between two groups There was a highly significant longer time interval from the time of eradication of varices till the end of the study in group I than in group II. In group I, time interval (5-32 months) while in group II, was slightly shorter (3-28 months).
Difference between basal laboratory measurements and laboratory measurements at the end of the study in group I, there was significant difference in the total bilirubin as well as AFP, while, in group II, there was significant difference in total bilirubin, serum albumin, platelets counts and total leucocytic count.
There was a positive significant correlation between serum urea and serum creatinine with time interval in group II.
There was significant different between both groups at the end of the study in Damping index with Cut-off level at 0.365 with sensitivity of 86% and specificity of 48.4%,
There was positive correlation between Damping index serum albumin and negative correlation with serum urea in group I.
Negative significant correlation was found between recurrence of esophageal varices to time interval in both groups, and positive significant correlation between recurrence of esophageal varices to age in group II.
Positive significant correlation was noticed between recurrence of the esophageal varices and total leucocytic count in group I, and with hemoglobin level in group II.
There was positive correlation between liver size in (cm) with AST level and serum creatinine in group II.
Positive highly significant correlation was found between portal vein diameter and spleen size in group II.
There was negative significant correlation between portal vein diameter and AFP level in group I, While, a positive significant correlation with serum albumin and negative correlation with serum creatinine, platelets count, total leucocytic count, and hemoglobin level in group II.
There was a negative significant correlation between splenic size with prothrombin time, serum urea, serum creatinine and total leucocytic count, and high significant correlation with platelets count in patients who did not receive propranolol.
CONCLUSIONS
• Propranolol use safely and significantly delayed, but did not reduce the recurrence of esophageal varices.
• Propranolol should be considered as treatment of choice for patients with variceal bleeding, few days later, after management and control the bleeding.
• Damping index at Cut-off level of 0.365 may be used propranolol to diminish the recurrence and prolong interval period till reappear the varices with sensitivity of 86%, and specificity 48.4%.
RECOMMENDATIONS
• Further randomized studies should be done with large number of patients and longer duration to assess patient’s survival.
• A priority for research in the forthcoming years is to develop accurate non-invasive methods to assess prognosis, which can be used to substitute or as surrogate indicators of the HVPG response.
• Reassessment of Damping index should be done on a larger number of patients with varices and correlated with HVPG.
• Large comparative studies to detect the efficacy of propranolol alone vs. addition of isosorbide mononitrate to propranolol vs. Carvedilol should be done.