Endoscopy, Digestive System ; Esophageal and Gastric Varices ; complications ; drug therapy ; surgery ; therapy ; Fibrosis ; complications ; Gastrointestinal Hemorrhage ; drug therapy ; etiology ; surgery ; therapy ; Humans ; Hypertension, Portal ; drug therapy ; etiology ; surgery ; therapy

Gastrointestinal Hemorrhage ; drug therapy ; etiology ; prevention & control ; Humans ; Hypertension, Portal ; complications

Liver cirrhosis is a major global health burden worldwide due to its high risk of morbidity and mortality. Role of terlipressin for the management of liver cirrhosis related complications has been recognized during recent years. This paper aims to develop evidence-based clinical practice guidance on the use of terlipressin for liver cirrhosis related complications. Hepatobiliary Study Group of Chinese Society of Gastroenterology of Chinese Medical Association and Hepatology Committee of Chinese Research Hospital Association have invited gastroenterologists, hepatologists, infectious disease specialists, surgeons, and clinical pharmacists to formulate the clinical practice guidance based on comprehensive literature review and experts' clinical experiences. Overall, 10 major statements regarding efficacy and safety of terlipressin in liver cirrhosis were proposed. Terlipressin can be beneficial for the management of cirrhotic patients with acute variceal bleeding and hepatorenal syndrome (HRS). However, the evidence regarding the use of terlipressin in cirrhotic patients with ascites, post-paracentesis circulatory dysfunction, and bacterial infections and in those undergoing hepatic resection and liver transplantation remains insufficient. Terlipressin-related adverse events, mainly including gastrointestinal symptoms, electrolyte disturbance, and cardiovascular and respiratory adverse events, should be closely monitored. The current clinical practice guidance supports the use of terlipressin for gastroesophageal variceal bleeding and HRS in liver cirrhosis. High-quality studies are needed to further clarify its potential effects in other liver cirrhosis related complications.
Electrolytes ; Esophageal and Gastric Varices/drug therapy* ; Gastrointestinal Hemorrhage/etiology* ; Hepatorenal Syndrome/etiology* ; Humans ; Liver Cirrhosis/drug therapy* ; Lypressin/adverse effects* ; Terlipressin/adverse effects* ; Vasoconstrictor Agents/adverse effects*

Catheterization ; Endoscopy ; Esophageal and Gastric Varices ; complications ; drug therapy ; surgery ; therapy ; Gastrointestinal Hemorrhage ; drug therapy ; etiology ; surgery ; therapy ; Humans ; Octreotide ; therapeutic use ; Somatostatin ; therapeutic use ; Vasopressins ; therapeutic use

OBJECTIVETo observe the therapeutic effect of rhubarb and Sanchi Powder (RSP) in treating patients with hemorrhagic fever in nephrotic syndrome (NS) complicated with digestive tract bleeding.

METHODSSixty patients clinically diagnosed as hemorrhagic fever in NS complicated with digestive tract bleeding were randomized into 2 groups. Fine ground rhubarb (3g) and SP (2g) were given orally to the patients in the treated group 3 - 4 times daily. Dicynonum (2g) was given by intravenously dripping to the patients in the control group.

RESULTSIn the treated group, 17 patients were cured, 5 markedly effective and 6 effective, with the markedly effective rate of 70.97% and the total effective rate of 90.32%. The corresponding number in the control group was 10, 3, 6, 44.83% and 65.52%, respectively, significant difference was shown in comparison between the two groups (P < 0.05 or P < 0.01). The average hemostatic time was (2.32 +/- 0.82) h, the platelet count was (8.84 +/- 1.13) x 10(9) /L, and the platelet aggregation rate was obviously improved in the treated group, which were significantly different to those in the control group [(4.15 +/- 0.69) h, (6.22 +/- 0.89) x 10(9)/L, respectively, P<0.01).

CONCLUSIONRSP has the action of promoting vasoconstriction, shortening the bleeding time and blood arresting, it can increase the platelet count and improve the platelet aggregation.

Adult ; Aged ; Araliaceae ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Gastrointestinal Hemorrhage ; drug therapy ; etiology ; Hemorrhagic Fever with Renal Syndrome ; complications ; drug therapy ; Humans ; Male ; Middle Aged ; Phytotherapy ; Rheum

Esophageal and Gastric Varices ; drug therapy ; etiology ; Female ; Gastrointestinal Agents ; therapeutic use ; Gastrointestinal Hemorrhage ; drug therapy ; etiology ; Glucagon ; blood ; Humans ; Liver Cirrhosis ; complications ; Male ; Middle Aged ; Nitric Oxide ; blood ; Octreotide ; therapeutic use ; Somatostatin ; analogs & derivatives

Hemophagocytic syndrome (HPS) is an uncommon hematological disorder that manifests as fever, splenomegaly, and jaundice, with hemophagocytosis in the bone marrow and other tissues pathologically. Secondary HPS is associated with malignancy and infection, especially viral infection. The prevalence of cytomegalovirus (CMV) infection in ulcerative colitis (UC) patients is approximately 16%. Nevertheless, HPS in UC superinfected by CMV is very rare. A 52-year-old female visited the hospital complaining of abdominal pain and hematochezia for 6 days. She was diagnosed with UC 3 years earlier and had been treated with sulfasalazine, but had stopped her medication 4 months earlier. On admission, her spleen was enlarged. The peripheral blood count revealed pancytopenia and bone marrow aspiration smears showed hemophagocytosis. Viral studies revealed CMV infection. She was treated successfully with ganciclovir. We report this case with a review of the related literature.
Antiviral Agents/therapeutic use ; Colitis, Ulcerative/*complications/drug therapy ; Cytomegalovirus Infections/*complications/drug therapy ; Female ; Ganciclovir/therapeutic use ; Gastrointestinal Agents/therapeutic use ; Gastrointestinal Hemorrhage/etiology ; Humans ; Lymphohistiocytosis, Hemophagocytic/drug therapy/*virology ; Middle Aged ; Sulfasalazine/therapeutic use ; Superinfection/*complications

Adult ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Esophageal and Gastric Varices ; drug therapy ; etiology ; Female ; Gastrointestinal Hemorrhage ; drug therapy ; etiology ; Humans ; Infusions, Intravenous ; Liver Cirrhosis ; complications ; drug therapy ; Male ; Middle Aged ; Phytotherapy

Colonic necrosis is known as a rare complication following the administration of Kayexalate (sodium polystryrene sulfonate) in sorbitol. We report a rare case of colonic mucosal necrosis following Kalimate (calcium polystryrene sulfonate), an analogue of Kayexalate without sorbitol in a 34-yr-old man. He had a history of hypertension and uremia. During the management of intracranial hemorrhage, hyperkalemia developed. Kalimate was administered orally and as an enema suspended in 20% dextrose water to treat hyperkalemia. Two days after administration of Kalimate enema, he had profuse hematochezia, and a sigmoidoscopy showed diffuse colonic mucosal necrosis in the rectum and sigmoid colon. Microscopic examination of random colonic biopsies by two consecutive sigmoidoscopies revealed angulated crystals with a characteristic crystalline mosaic pattern on the ulcerated mucosa, which were consistent with Kayexalate crystals. Hematochezia subsided with conservative treatment after a discontinuance of Kalimate administration.
Adult ; Colon/*pathology ; Gastrointestinal Hemorrhage/etiology ; Humans ; Hyperkalemia/drug therapy ; Intestinal Mucosa/*pathology ; Male ; Necrosis/*chemically induced/complications/pathology ; Polystyrenes/*adverse effects/therapeutic use ; Uremia/*physiopathology

Esophageal varices(EV) are present in 40% and 60% of Child-Pugh A and C patients, respectively when cirrhosis is diagnosed. EV bleeding is a life-threatening complication of liver cirrhosis with a high probability of recurrence. Treatment to prevent first EV bleeding or rebleeding is mandatory. In small EV with high risk of bleeding, nonselective beta-blockers should be used for the prevention of first variceal bleeding. For medium to large EV, nonselective beta-blockers or endoscopic variceal ligation (EVL) may be recommended to high risk varices. But, nonselective beta-blockers are the first treatment option to non-high risk varices and EVL is an alternative when nonselective beta-blockers are contraindicated or not tolerated. For the prevention of rebleeding, a combination of nonselective beta-blockers and EVL may be the best option. A great improvement in the prevention of variceal bleeding has emerged over the last years. However, further therapeutic options that combine higher efficacy, better tolerance and fewer side effects are needed.
Adrenergic beta-Antagonists/therapeutic use ; Esophageal and Gastric Varices/drug therapy/*prevention & control ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Ligation ; Portasystemic Shunt, Transjugular Intrahepatic ; Sclerotherapy