studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 583A
fixed effects model to assess the primary outcome (incidence
of gastric variceal rebleeding) and secondary outcomes (complete
obliteration of gastric varices, aggravation of esophageal
varices and mortality rate). Review Manager 5.3 software program
was utilized for statistical analysis. Results: The search
yielded three studies involving 206 patients. The mean percentage
of patients with gastric variceal rebleeding was 21%
in the EIT group and 4% in the BRTO group, with a mean odds
ratio of 0.13, P < 0.01 (95% CI: 0.03-0.47).The percentage of
patients with complete obliteration of gastric varices was 74%
in the EIT group and 95% in the BRTO group: odds ratio 9.40,
P < 0.01 (95% CI: 2.32-38.02). There was no significant difference
for aggravation of esophageal varices and mortality
rate between the two groups. Conclusions: Balloon-occluded
retrograde transvenous obliteration was more effective than
endoscopic injection therapy in the eradication of GV and
prevention of rebleeding.
Rebleeding rate BRTO vs EIT
(6.1% vs 6.5%, p=1.000) and 5-day mortality (5.3% vs 4.9%,
p=1.000) in PPI group and control group. PPI group showed
less 6-week rebleeding rate (12.1 % vs 22.8%, p=0.031) than
control group while 6-week mortality was similar between
two groups (7.6% vs 6.5% respectively, p=0.810). PPI group
showed better event free survival compared to control group
over control group (p=0.019 by Log Rank test). Multivariate
analysis identified Child-Pugh score as a predictor for 5-day
treatment failure (HR 1.648, 95%CI 1.139-2.384, p=0.008).
Child-Pugh score and PPI therapy were identified as independent
predictors for 6-week treatment failure (HR, 1.328, 95%CI
1.096-1.610 p=0.004 and HR, 0.465, 95%CI 0.233-0.931,
p=0.031). The occurrence of serious infection was similar
between two groups (3.8% and 6.5%, respectively p=0.399)
Conclusion: PPI therapy can offer advantage of decrease the
rate of recurrent bleeding in cirrhotic patients with acute variceal
bleeding. PPI could be safely used in patients with liver
cirrhosis by careful selection of candidate.
Cox’s univariate and multivariate analysis of predictors of 6-week
treatment failure
Disclosures:
The following authors have nothing to disclose: Dina Ahmad, Mohammad
Esmadi, Shadi Hamdeh, Kunut Kijsirichareanchai, Chijioke U. Enweluzo, Saurabh
Kapur, Marco A. Olivera-Martinez
749
Prospective validation of the efficacy of proton pump
inhibitors in acute gastroesophageal variceal bleeding
in patients with cirrhosis: A single center case-control
study
Soo Young Park 1 , Se Young Jang 1 , Su Hyun Lee 1 , Yu Rim Lee 1 , Sun
Kyung Jang 1 , Won Young Tak 1 , Young Oh Kweon 1 , Jeong Heo 2 ,
Hyun Young Woo 2 , Won Lim 2 , Jung Gil Park 3 , Keun Hur 4 , Gyeonghwa
Kim 4 , Yong-Hun Choi 4 ; 1 Hepatology, Kyungpook National
University Hospital, Daegu, Korea (the Republic of); 2 Department
of Internal Medicine, Pusan National University Hospital, Pusan,
Korea (the Republic of); 3 Internal Medicine, CHA University Gumi
CHA Medical Center, Gumi, Korea (the Republic of); 4 Department
of Biochemistry, Kyungpook National University, Daegu, Korea
(the Republic of)
Background and aims: The efficacy and safety of PPI in patient s
with acute variceal bleeding have not evaluated yet. Therefore,
we aimed to determine the efficacy and safety of long-term
proton pump inhibitors in acute gastroesophageal bleeding
by reviewing prospective cohort of patients with liver cirrhosis.
Patients and methods: Patients with acute variceal bleeding
were prospectively evaluated for 5-day in-hospital failure,
6-week failure and recurrent bleeding afterwards. A total
of 353 patients with liver cirrhosis visited for acute variceal
bleeding from 2008 to 2013. We enrolled 255 patients by
excluding 47 patients with non-variceal bleeding and 51 with
HCC with portal vein thrombosis. Patients were prospectively
evaluated according to previous protocols evaluating treatment
outcome in acute gastroesophageal variceal bleeding (Hepatology
2015;61:1033) Five day in-hospital treatment failures
were determined by Baveno V criteria and rebleeding within
6 weeks were prospectively evaluated Results: No differences
were observed regarding baseline characteristics of patients
with PPI group (n=132) and control group (n=123). There
were no significant differences in 5-day treatment failure rate
Disclosures:
Won Young Tak - Advisory Committees or Review Panels: Gilead Korea; Grant/
Research Support: SAMIL Pharma; Speaking and Teaching: Bayer Korea
Jeong Heo - Advisory Committees or Review Panels: Abbvie; Grant/Research
Support: Roche
The following authors have nothing to disclose: Soo Young Park, Se Young Jang,
Su Hyun Lee, Yu Rim Lee, Sun Kyung Jang, Young Oh Kweon, Hyun Young Woo,
Won Lim, Jung Gil Park, Keun Hur, Gyeonghwa Kim, Yong-Hun Choi
750
Atorvastatin and propranolol combination cause greater
reduction of HVPG than propranolol alone in patients of
cirrhosis with portal hypertension
Saptarshi Bishnu 1 , Avik Sarkar 2 , Saswata Chatterjee 1 , Sk Mahiuddin
Ahammed 1 , Kshaunish Das 3 , Kausik Das 1 , Gopal K. Dhali 3 ,
Abhijit Chowdhury 1 ; 1 Department of Hepatology, School of Digestive
and Liver Diseases, Institute of Postgraduate Medical Education
and Research, Kolkata, India; 2 Department of GI Radiology,
School of Digestive and Liver Diseases, Institute of Postgraduate
Medical Education and Research, Kolkata, India; 3 Department of
Gastroenterology, School of Digestive and Liver Diseases, Institute
of Postgraduate Medical Education and Research, Calcutta, India
Introduction:Statins can modulate portal microvascular dynamics
in cirrhotic patients. We present preliminary data from a
study aimed at comparing combination of propranolol (Ppnl)
and atorvastatin versus Ppnl alone in reducing portal pressure
in cirrhosis. Methods:In this open-label study, 23 consecutive
cirrhotic patients were randomized into Arm A (atorvastatin
20 mg daily with Ppnl in incremental dose, n=11) or Arm B
(incremental dose Ppnl, n=12). Hepatic venous pressure gradient
(HVPG) was estimated at baseline and after 30 days.
Results:The 2 arms were matched with respect to etiology,
Child status and baseline HVPG (Table 1). Decrease of wedged
hepatic venous pressure, free hepatic venous pressure and
HVPG in Arm A and Arm B after 30 days were 6.09±3.56 vs
4.67±2.57 (p=0.290), 1.27±1.67 vs 1.83±2.62 (p=0.546)
and 4.81±2.82 vs 2.58±1.88 mm Hg (p=0.041) respectively.
Conclusion:HVPG decrease in cirrhotics treated with atorvasta-