Brief Article
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World J Gastroenterol. Jul 14, 2013; 19(26): 4228-4233
Published online Jul 14, 2013. doi: 10.3748/wjg.v19.i26.4228
Effects of propranolol or propranolol plus isosorbide-5-mononitrate on variceal pressure in schistosomiasis
De-Run Kong, Chao Ma, Min Wang, Jing-Guang Wang, Chen Chen, Lei Zhang, Jia-Hu Hao, Pan Li, Jian-Ming Xu
De-Run Kong, Jing-Guang Wang, Chen Chen, Lei Zhang, Pan Li, Jian-Ming Xu, Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Chao Ma, Department of Gastroenterology, Fuyang Second People’s Hospital, city, Fuyang 236015, Anhui Province, China
Min Wang, Department of Medicine, Tongling Vocational Technology College, Tongling 244003, Anhui Province, China
Jia-Hu Hao, Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, Anhui Province, China
Author contributions: Kong DR, Ma C and Wang M contributed equally to this work; Kong DR, Ma C and Wang M were involved in acquisition, analysis and interpretation of data, and drafting of the manuscript; Wang JG, Li P and Chen C were involved in acquisition, analysis and interpretation of data; Zhang L provided technical support and was involved in study supervision; Hao JH was involved in study design, statistical analysis and study supervision; Xu JM was involved in study design, analysis and interpretation of data, critical revision of the manuscript and study supervision.
Supported by Educational and Health Department of Anhui Province, No. KJ2010A158, KJ2012Z189, 2010B018; General Program of National Natural Science Foundation of China, No. 81070337, 81271736
Correspondence to: Jian-Ming Xu, MD, Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, Anhui Province, China. xjm1017@yahoo.com.cn
Telephone: +86-551-62922105 Fax: +86-551-65120742
Received: November 20, 2012
Revised: May 22, 2013
Accepted: June 5, 2013
Published online: July 14, 2013
Abstract

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.

Keywords: Esophageal varices, Schistosomiasis, Portal hypertension, Bleeding, Propranolol, Variceal pressure, Isosorbide-5-mononitrate

Core tip: The results of the present study suggested that the combination of propranolol and isosorbide-5-mononitrate was more effective than propranolol alone in decreasing variceal pressure. This drug combination will reduce the rate of bleeding in patients with schistosomiasis, high-risk esophageal varices and no previous history of variceal bleeding.