Advances in the integrated traditional Chinese and Western medicine diagnosis and treatment of gastroesophageal variceal bleeding due to liver cirrhosis

Yongping MU

doi:10.3969/j.issn.1001-5256.2022.09.003

Volume 38 Issue 9

Sep. 2022

Turn off MathJax

Article Contents

Article Navigation > Journal of Clinical Hepatology > 2022 > 38(9): 1962-1968

PDF( 2131 KB)

Advances in the integrated traditional Chinese and Western medicine diagnosis and treatment of gastroesophageal variceal bleeding due to liver cirrhosis

DOI: 10.3969/j.issn.1001-5256.2022.09.003

Yongping MU^{,
,}

Second Department of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Institute of Liver Diseases, Shanghai Institute of Traditional Chinese Medicine; Key Laboratory of Liver and Kidney Diseases of the Ministry of Education; Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai 201203, China

Research funding:

National Natural Science Foundation of China (81874390);

Natural Science Foundation of Shanghai (21ZR1464100);

Special Project for Biomedical Science and Technology Support of "Science and Technology Innovation Action Plan" of Shanghai Science and Technology Commission (22S11901700);

Shanghai Key Specialty of Traditional Chinese Clinical Medicine (shslczdzk01201)

More Information

Corresponding author: MU Yongping, ypmu8888@126.com(ORCID: 0000-0002-6808-8243)
Received Date: 2022-06-13
Accepted Date: 2022-07-15
Published Date: 2022-09-20

Abstract

Abstract

Portal hypertension is not only the outcome of liver cirrhosis, but also the main cause of gastroesophageal varices, and variceal bleeding may lead to dangerous conditions and even endanger the life of patients. Therefore, standardization of endoscopic screening, prevention of first-time bleeding, emergency hemostasis, and prevention of secondary bleeding after hemostasis are of great importance for the prevention and treatment of gastroesophageal variceal bleeding. At present, the treatment measures for emergency hemostasis mainly include circulatory resuscitation, pharmacotherapy, endoscopic therapy, interventional radiology, and transjugular intrahepatic portosystemic shunt for patients who may fail in routine treatment. Secondary preventive measures mainly include traditional nonselective β-receptor blocker (NSBB) or carvedilol combined with endoscopic variceal ligation, transjugular intrahepatic portosystemic shunt, and balloon-occluded retrograde transvenous obliteration. In addition, traditional Chinese medicine or integrated traditional Chinese and Western medicine therapy also play an important role in the treatment of gastroesophageal variceal bleeding, especially in the fields of primary and secondary prevention. This article reviews the research advances in the role of integrated traditional Chinese and Western medicine therapy in the diagnosis and treatment of gastroesophageal variceal bleeding due to liver cirrhosis in recent years, in order to provide a reference for clinicians to select appropriate diagnosis and treatment regimens.
- Liver Cirrhosis,
- Esophageal and Gastric Varices,
- Therapeutics

FullText(HTML)

References(47)

References

[1]	de FRANCHIS R, BOSCH J, GARCIA-TSAO G, et al. Baveno Ⅶ-Renewing consensus in portal hypertension[J]. J Hepatol, 2022, 76(4): 959-974. DOI: 10.1016/j.jhep.2021.12.022.
[2]	LESMANA C, RAHARJO M, GANI RA. Managing liver cirrhotic complications: Overview of esophageal and gastric varices[J]. Clin Mol Hepatol, 2020, 26(4): 444-460. DOI: 10.3350/cmh.2020.0022.
[3]	PONS M, AUGUSTIN S, SCHEINER B, et al. Noninvasive diagnosis of portal hypertension in patients with compensated advanced chronic liver disease[J]. Am J Gastroenterol, 2021, 116(4): 723-732. DOI: 10.14309/ajg.0000000000000994.
[4]	SHIN SU, LEE JM, YU MH, et al. Prediction of esophageal varices in patients with cirrhosis: usefulness of three-dimensional MR elastography with echo-planar imaging technique[J]. Radiology, 2014, 272(1): 143-153. DOI: 10.1148/radiol.14130916.
[5]	GARCIA-TSAO G, ABRALDES JG, BERZIGOTTI A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases[J]. Hepatology, 2017, 65(1): 310-335. DOI: 10.1002/hep.28906.
[6]	SARIN SK, KUMAR A. Gastric varices: profile, classification, and management[J]. Am J Gastroenterol, 1989, 84(10): 1244-1249. http://gut.bmj.com/external-ref?access_num=2679046&link_type=MED
[7]	JAKAB SS, GARCIA-TSAO G. Evaluation and management of esophageal and gastric varices in patients with cirrhosis[J]. Clin Liver Dis, 2020, 24(3): 335-350. DOI: 10.1016/j.cld.2020.04.011.
[8]	ARDEVOL A, IBAÑEZ-SANZ G, PROFITOS J, et al. Survival of patients with cirrhosis and acute peptic ulcer bleeding compared with variceal bleeding using current first-line therapies[J]. Hepatology, 2018, 67(4): 1458-1471. DOI: 10.1002/hep.29370.
[9]	CHAVEZ-TAPIA NC, BARRIENTOS-GUTIERREZ T, TELLEZ-AVILA F, et al. Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding - an updated Cochrane review[J]. Aliment Pharmacol Ther, 2011, 34(5): 509-518. DOI: 10.1111/j.1365-2036.2011.04746.x.
[10]	Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Endoscopy, Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002. 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002.
[11]	DAI C, LIU WX, JIANG M, et al. Endoscopic variceal ligation compared with endoscopic injection sclerotherapy for treatment of esophageal variceal hemorrhage: a meta-analysis[J]. World J Gastroenterol, 2015, 21(8): 2534-2541. DOI: 10.3748/wjg.v21.i8.2534.
[12]	KANWAL F, TAPPER EB, HO C, et al. Development of quality measures in cirrhosis by the practice metrics committee of the American Association for the Study of Liver Diseases[J]. Hepatology, 2019, 69(4): 1787-1797. DOI: 10.1002/hep.30489.
[13]	AL-ALI J, PAWLOWSKA M, COSS A, et al. Endoscopic management of gastric variceal bleeding with cyanoacrylate glue injection: safety and efficacy in a Canadian population[J]. Can J Gastroenterol, 2010, 24(10): 593-596. DOI: 10.1155/2010/276273.
[14]	KAHLOON A, CHALASANI N, DEWITT J, et al. Endoscopic therapy with 2-octyl-cyanoacrylate for the treatment of gastric varices[J]. Dig Dis Sci, 2014, 59(9): 2178-2183. DOI: 10.1007/s10620-014-3148-9.
[15]	RÍOS CASTELLANOS E, SERON P, GISBERT JP, et al. Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension[J]. Cochrane Database Syst Rev, 2015, (5): CD010180. DOI: 10.1002/14651858.CD010180.pub2.
[16]	BHAT YM, WEILERT F, FREDRICK RT, et al. EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years (with video)[J]. Gastrointest Endosc, 2016, 83(6): 1164-1172. DOI: 10.1016/j.gie.2015.09.040.
[17]	WEIL D, CERVONI JP, FARES N, et al. Management of gastric varices: a French national survey[J]. Eur J Gastroenterol Hepatol, 2016, 28(5): 576-581. DOI: 10.1097/MEG.0000000000000560.
[18]	LEE HA, CHANG JM, GOH HG, et al. Prognosis of patients with gastric variceal bleeding after endoscopic variceal obturation according to the type of varices[J]. Eur J Gastroenterol Hepatol, 2019, 31(2): 211-217. DOI: 10.1097/MEG.0000000000001271.
[19]	IMAI Y, NAKAZAWA M, ANDO S, et al. Long-term outcome of 154 patients receiving balloon-occluded retrograde transvenous obliteration for gastric fundal varices[J]. J Gastroenterol Hepatol, 2016, 31(11): 1844-1850. DOI: 10.1111/jgh.13382.
[20]	LEE SJ, KIM SU, KIM MD, et al. Comparison of treatment outcomes between balloon-occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt for gastric variceal bleeding hemostasis[J]. J Gastroenterol Hepatol, 2017, 32(8): 1487-1494. DOI: 10.1111/jgh.13729.
[21]	CHU HH, KIM M, KIM HC, et al. Long-term outcomes of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices: a comparison of ethanolamine oleate and sodium tetradecyl sulfate[J]. Cardiovasc Intervent Radiol, 2018, 41(4): 578-586. DOI: 10.1007/s00270-017-1869-9.
[22]	STEIN DJ, SALINAS C, SABRI S, et al. Balloon retrograde transvenous obliteration versus endoscopic cyanoacrylate in bleeding gastric varices: comparison of rebleeding and mortality with extended follow-up[J]. J Vasc Interv Radiol, 2019, 30(2): 187-194. DOI: 10.1016/j.jvir.2018.12.008.
[23]	CHAU TN, PATCH D, CHAN YW, et al. "Salvage" transjugular intrahepatic portosystemic shunts: gastric fundal compared with esophageal variceal bleeding[J]. Gastroenterology, 1998, 114(5): 981-987. DOI: 10.1016/s0016-5085(98)00640-4.
[24]	LAKHOO J, BUI JT, LOKKEN RP, et al. Transjugular intrahepatic portosystemic shunt creation and variceal coil or plug embolization ineffectively attain gastric variceal decompression or occlusion: results of a 26-patient retrospective study[J]. J Vasc Interv Radiol, 2016, 27(7): 1001-1011. DOI: 10.1016/j.jvir.2016.02.019.
[25]	SAAD WE. Combining transjugular intrahepatic portosystemic shunt with balloon-occluded retrograde transvenous obliteration or augmenting TIPS with variceal embolization for the management of gastric varices: an evolving middle ground?[J]. Semin Intervent Radiol, 2014, 31(3): 266-268. DOI: 10.1055/s-0034-1382796.
[26]	GARCÍA-PAGÁN JC, CACA K, BUREAU C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding[J]. N Engl J Med, 2010, 362(25): 2370-2379. DOI: 10.1056/NEJMoa0910102.
[27]	HERNÁNDEZ-GEA V, PROCOPET B, GIRÁLDEZ Á, et al. Preemptive-TIPS improves outcome in high-risk variceal bleeding: an observational study[J]. Hepatology, 2019, 69(1): 282-293. DOI: 10.1002/hep.30182.
[28]	LV Y, YANG Z, LIU L, et al. Early TIPS with covered stents versus standard treatment for acute variceal bleeding in patients with advanced cirrhosis: a randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2019, 4(8): 587-598. DOI: 10.1016/S2468-1253(19)30090-1.
[29]	ALBILLOS A, ZAMORA J, MARTÍNEZ J, et al. Stratifying risk in the prevention of recurrent variceal hemorrhage: Results of an individual patient meta-analysis[J]. Hepatology, 2017, 66(4): 1219-1231. DOI: 10.1002/hep.29267.
[30]	FUKUDA T, HIROTA S, SUGIMURA K. Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy[J]. J Vasc Interv Radiol, 2001, 12(3): 327-336. DOI: 10.1016/s1051-0443(07)61912-5.
[31]	HUNG HH, CHANG CJ, HOU MC, et al. Efficacy of non-selective β-blockers as adjunct to endoscopic prophylactic treatment for gastric variceal bleeding: a randomized controlled trial[J]. J Hepatol, 2012, 56(5): 1025-1032. DOI: 10.1016/j.jhep.2011.12.021.
[32]	LO GH, LIANG HL, CHEN WC, et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding[J]. Endoscopy, 2007, 39(8): 679-685. DOI: 10.1055/s-2007-966591.
[33]	MISHRA SR, CHANDER SHARMA B, KUMAR A, et al. Endoscopic cyanoacrylate injection versus beta-blocker for secondary prophylaxis of gastric variceal bleed: a randomised controlled trial[J]. Gut, 2010, 59(6): 729-735. DOI: 10.1136/gut.2009.192039.
[34]	LUO X, XIANG T, WU J, et al. Endoscopic cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration for prevention of gastric variceal bleeding: a randomized controlled trial[J]. Hepatology, 2021, 74(4): 2074-2084. DOI: 10.1002/hep.31718.
[35]	MU YP, LIU CH, ZHANG H, et al. Theory of "asthenia and deficiency cause accumulation" in liver cirrhosis--Brief analysis on academic system of Professor Liu Ping[J]. Acta Univ Tradit Med Sin Pharmacol Shanghai, 2013, 27(2): 1-4. DOI: 10.16306/j.1008-861x.2013.02.006. 慕永平, 刘成海, 张华, 等. 肝硬化"虚损生积"论——刘平教授学术思想浅析[J]. 上海中医药大学学报, 2013, 27(2): 1-4. DOI: 10.16306/j.1008-861x.2013.02.006.
[36]	CHEN C, LYU Y, CHEN XL, et al. Effect of endoscopic ligation combined with traditional Chinese medicine syndrome differentiation-based treatment in the secondary prevention of esophageal variceal bleeding in patients with liver cirrhosis[J]. J Clin Hepatol, 2022, 38(5): 1075-1080. DOI: 10.3969/j.issn.1001-5256.2022.05.019. 陈冲, 吕莹, 陈茜蕾, 等. 内镜结扎联合中医辨证论治对肝硬化食管静脉曲张破裂出血的二级预防效果[J]. 临床肝胆病杂志, 2022, 38(5): 1075-1080. DOI: 10.3969/j.issn.1001-5256.2022.05.019.
[37]	XIAO DH, GU J, CAI H, et al. A randomized placebo-controlled multicentre study of Fuzhenghuayu capsule for prevention of oesophageal variceal bleeding in patients with liver cirrhosis[J]. Chin J Hepatol, 2014, 22(8): 594-599. DOI: 10.3760/cma.j.issn.1007-3418.2014.08.009. 肖定洪, 顾杰, 蔡虹, 等. 扶正化瘀胶囊预防肝硬化患者食管静脉曲张破裂出血的随机对照多中心临床研究[J]. 中华肝脏病杂志, 2014, 22(8): 594-599. DOI: 10.3760/cma.j.issn.1007-3418.2014.08.009.
[38]	GARCIA-TSAO G, SANYAL AJ, GRACE ND, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis[J]. Hepatology, 2007, 46(3): 922-938. DOI: 10.1002/hep.21907.
[39]	SARIN SK, KUMAR A, ANGUS PW, et al. Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver[J]. Hepatol Int, 2008, 2(4): 429-439. DOI: 10.1007/s12072-008-9096-8.
[40]	GROSZMANN RJ, GARCIA-TSAO G, BOSCH J, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis[J]. N Engl J Med, 2005, 353(21): 2254-2261. DOI: 10.1056/NEJMoa044456.
[41]	MANDORFER M, BOTA S, SCHWABL P, et al. Nonselective β blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis[J]. Gastroenterology, 2014, 146(7): 1680-1690. DOI: 10.1053/j.gastro.2014.03.005.
[42]	SERSTÉ T, MELOT C, FRANCOZ C, et al. Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites[J]. Hepatology, 2010, 52(3): 1017-1022. DOI: 10.1002/hep.23775.
[43]	TERGAST TL, KIMMANN M, LASER H, et al. Systemic arterial blood pressure determines the therapeutic window of non-selective beta blockers in decompensated cirrhosis[J]. Aliment Pharmacol Ther, 2019, 50(6): 696-706. DOI: 10.1111/apt.15439.
[44]	SHARMA M, SINGH S, DESAI V, et al. Comparison of therapies for primary prevention of esophageal variceal bleeding: A systematic review and network meta-analysis[J]. Hepatology, 2019, 69(4): 1657-1675. DOI: 10.1002/hep.30220.
[45]	MISHRA SR, SHARMA BC, KUMAR A, et al. Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: a randomized controlled trial[J]. J Hepatol, 2011, 54(6): 1161-1167. DOI: 10.1016/j.jhep.2010.09.031.
[46]	LIU P, HU YY, LIU C, et al. Multicenter clinical study about the action of Fuzheng Huayu Capsule against liver fibrosis with chronic hepatitis B[J]. J Chin Integr Med, 2003, 1(2): 89-98, 102. https://www.cnki.com.cn/Article/CJFDTOTAL-XBZX200302003.htm 刘平, 胡义扬, 刘成, 等. 扶正化瘀胶囊干预慢性乙型肝炎肝纤维化作用的多中心临床研究[J]. 中西医结合学报, 2003, 1(2): 89-98, 102. https://www.cnki.com.cn/Article/CJFDTOTAL-XBZX200302003.htm
[47]	CHEN Y, YANG YP. The role of traditional Chinese medicine in blocking and reversing hepatic fibrosis: current status, hope, and challenge[J]. J Clin Hepatol, 2018, 34(4): 689-693. DOI: 10.3969/j.issn.1001-5256.2018.04.002. 陈艳, 杨永平. 中医药阻断逆转肝纤维化的现状、希望与挑战[J]. 临床肝胆病杂志, 2018, 34(4): 689-693. DOI: 10.3969/j.issn.1001-5256.2018.04.002.

Relative Articles

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(1)

Get Citation

PDF

XML

Article Metrics

Article views (982) PDF downloads(130)

Advances in the integrated traditional Chinese and Western medicine diagnosis and treatment of gastroesophageal variceal bleeding due to liver cirrhosis

DOI: 10.3969/j.issn.1001-5256.2022.09.003

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Advances in the integrated traditional Chinese and Western medicine diagnosis and treatment of gastroesophageal variceal bleeding due to liver cirrhosis

DOI: 10.3969/j.issn.1001-5256.2022.09.003

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

About Journal

Submission Guideline

Journal Online

Hepatobiliary College

Guidelines

Export File

Citation

Format

Content