Hemodynamic effects of propranolol with spironolactone in patients with variceal bleeds: A randomized controlled trial.

Author(s): De BK, Dutta D, Som R, Biswas PK, Pal SK, Biswas A

Affiliation(s): Department of Medicine, Medical College, 64/4A/1A Dr. Suresh Chandra Banerjee Road, Calcutta 700010, India. binaykde@hotmail.com.

Publication date & source: 2008-03-28, World J Gastroenterol., 14(12):1908-13.

Publication type:

AIM: To study the hemodynamic effects of spironolactone with propranolol vs propranolol alone in the secondary prophylaxis of variceal bleeding. METHODS: Thirty-five cirrhotics with variceal bleeding randomly received propranolol (n = 17: Group A) or spironolactone plus propranolol (n = 18: Group B). Hemodynamic assessment was performed at baseline and on the eighth day. RESULTS: Spironolactone with propranolol caused a greater reduction in the hepatic venous pressure gradient than propranolol alone (26.94% vs 10.2%; P < 0.01). Fourteen out of eighteen patients on the combination treatment had a reduction in hepatic venous pressure gradient to <= 12 mmHg or a 20% reduction from baseline in contrast to only six out of seventeen (6/17) on propranolol alone (P < 0.05). CONCLUSION: Spironolactone with propranolol results in a better response with a greater reduction in hepatic venous pressure gradient in the secondary prophylaxis of variceal bleeding. A greater number of patients may be protected by this combination therapy than by propranolol alone. Hence, this combination may be recommended for secondary prophylaxis in patients with variceal bleeding.