Effects of propranolol or propranolol plus isosorbide-5-mononitrate on variceal
pressure in schistosomiasis.
Author(s): Kong DR(1), Ma C, Wang M, Wang JG, Chen C, Zhang L, Hao JH, Li P, Xu JM.
Affiliation(s): Author information:
(1)Department of Gastroenterology, First Affiliated Hospital of Anhui Medical
University, Hefei 230022, Anhui Province, China.
Publication date & source: 2013, World J Gastroenterol. , 19(26):4228-33
AIM: To compare the effects of propranolol (PR) to that of PR plus
isosorbide-5-mononitrate (ISMN) on variceal pressure in patients with
schistosomiasis.
METHODS: Forty-eight patients with schistosomiasis who had no previous variceal
bleeding were treated with PR alone or PR plus ISMN. Seven patients refused
variceal pressure manometry (3 receiving PR and 4 receiving PR plus ISMN). One
patient withdrew from the trial due to headache after taking ISMN. At the time of
termination, twenty patients were randomly assigned to treatment with PR plus
ISMN or PR alone. The dose of PR was adjusted until the resting heart rate had
been reduced by 25% or was less than 55 bpm. In the PR plus ISMN group, after PR
was titrated to the same target, the dose of ISMN was increased up to 20 mg
orally twice a day. Variceal pressure was measured using a noninvasive endoscopic
balloon technique at the end of the 6-mo treatment period.
RESULTS: In 40 patients (20 in the PR group and 20 in the PR plus ISMN group),
variceal pressure was measured before treatment and at the end of the 6-mo
treatment period. PR or PR plus ISMN treatment caused a significant reduction in
variceal pressure (PR group: from 24.15 ± 6.05 mmHg to 22.68 ± 5.70 mmHg, P =
0.001; PR plus ISMN group: from 25.69 ± 5.26 mmHg to 20.48 ± 5.43 mmHg; P <
0.001). The percentage decrease in variceal pressure was significant after PR
plus ISMN compared with that after PR alone (15.93% ± 8.37% vs 6.05% ± 3.67%, P =
0.01). One patient in the PR plus ISMN group and two patients in the PR group had
variceal bleeding during follow-up. There were no significant differences between
the two groups regarding the incidence of variceal bleeding. In the PR plus ISMN
group, three patients had headache and hypotension. The headache was mild and
transient and promptly disappeared after continuation of the relevant drug in two
patients. Only one patient withdrew from the trial due to severe and lasting
headache after taking ISMN. No side effects occurred in the PR group.
CONCLUSION: PR plus ISMN therapy may be an alternative treatment for patients
with schistosomiasis who have a high risk of bleeding.
|