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World J Gastroenterol. Dec 28, 2006; 12(48): 7810-7814
Published online Dec 28, 2006. doi: 10.3748/wjg.v12.i48.7810
Management of digestive bleeding related to portal hypertension in cirrhotic patients: A French multicenter cross-sectional practice survey
Pierre Ingrand, Jérôme Gournay, Pierre Bernard, Frédéric Oberti, Brigitte Bernard-Chabert, Arnault Pauwels, Philippe Renard, Eric Bartoli, Jean-François Cadranel, Jean-Claude Barbare, Isabelle Ingrand, Michel Beauchant, The Club Francophone pour l’Etude de l’Hypertension Portale
Pierre Ingrand, Isabelle Ingrand, Clinical Research Center, Poitiers University, France
Jérôme Gournay, Hepato-Gastroenterology, Centre Hospitalier Universitaire, Nantes, France
Pierre Bernard, Hepato-Gastroenterology, Centre Hospitalier Universitaire Saint-André, Bordeaux, France
Frédéric Oberti, Hepato-Gastroenterology, Centre Hospitalier Universitaire, Angers, France
Brigitte Bernard-Chabert, Hepato-Gastroenterology, Centre Hospitalier Universitaire, Reims, France
Arnault Pauwels, Hepato-Gastroenterology, Centre Hospitalier, Gonesse, France
Philippe Renard, Hepato-Gastroenterology, Centre Hospitalier, Argenteuil, France
Eric Bartoli, Hepato-Gastroenterology, Centre Hospitalier Universitaire, Amiens, France
Jean-François Cadranel, Hepato-Gastroenterology, Centre Hospitalier, Creil, France
Jean-Claude Barbare, Hepato-Gastroenterology, Centre Hospitalier, Compiègne, France
Michel Beauchant, Hepato-Gastroenterology, Centre Hospitalier Universitaire, Poitiers, France
Supported by grants from the French Society of Gastroenterology
Correspondence to: Professor Pierre Ingrand, Clinical Research Center, Faculté de Médecine et de Pharmacie, 34 rue du Jardin des Plantes, BP 199, 86005 POITIERS, Cedex, France. pierre.ingrand@univ-poitiers.fr
Telephone: +33-5-49454345 Fax: +33-5-49454073
Received: October 10, 2006
Revised: October 28, 2006
Accepted: November 28, 2006
Published online: December 28, 2006
Abstract

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 for early 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.

Keywords: Digestive bleeding; Portal hypertension; Cirrhosis; Evaluation studies