https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.21907

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.28906

Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases.

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis.

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.1840220145

The treatment of portal hypertension: A meta-analytic review

https://www.journal-of-hepatology.eu/article/S0168-8278%2814%2900806-X/pdf

Molecular mechanism of PPARα action and its impact on lipid metabolism, inflammation and fibrosis in non-alcoholic fatty liver disease.

A new scoring system for prognostic stratification of patients with alcoholic hepatitis

Objective To investigate whether isosorbide-5-mononitrate (Is-5-Mn) given with propranolol reduces hepatic portal pressure more than does propranolol alone in patients with cirrhosis. Design A randomized controlled trial. Patients Fifty patients with cirrhosis and esophageal varices entered and 42 completed the study. Intervention Twenty-one patients received oral propranolol at increasing doses until their resting heart rate was reduced by 25%, and 21 patients received oral propranolol (on the same schedule) plus oral Is-5-Mn, 40 mg twice a day. Measurements Hepatic vein pressure gradient, liver function, and splanchnic and systemic hemodynamics before and after 3 months of continuous therapy. Main results At 3 months, the hepatic venous pressure gradient decreased more (P less than 0.01) in patients given propranolol plus Is-5-Mn (19%, from 18.4 +/- 3.9 to 14.9 +/- 3.8 mm Hg; 95% CI, -2.4 to -4.5 mm Hg) than in those given propranolol alone (10%, from 18.2 +/- 3.5 to 16.3 +/- 3.1 mm Hg; CI, -1.1 to -2.7 mm Hg). The hepatic venous pressure gradient decreased by more than 20% of the baseline value in 10% of patients receiving propranolol, but in 50% of patients receiving combined therapy (P less than 0.02). There were statistically significant decreases in hepatic blood flow and the intrinsic clearance of indocyanine green after propranolol therapy, but not after combined therapy. The treatments caused similar reductions in azygos blood flow and cardiac output. Conclusions The long-term combined administration of propranolol plus Is-5-Mn reduces portal pressure more than propranolol alone without adverse effects on hepatic perfusion and liver function. Whether this greater hemodynamic effect translates into better clinical efficacy should be determined in randomized controlled trials.

Propranolol compared with propranolol plus isosorbide-5-mononitrate for portal hypertension in cirrhosis. A randomized controlled study.

Objective: To investigate whether isosorbide-5-mononitrate (Is5-Mn) given with propranolol reduces hepatic portal pressure more than does propranolol alone in patients with cirrhosis. Design: A ran...

Propranolol Compared with Propranolol plus Isosorbide-5-Mononitrate for Portal Hypertension in Cirrhosis

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.1840170302

Hemodynamic and humoral changes after liver transplantation in patients with cirrhosis

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1053/he.2000.6779

Joan Carles García-Pagán

Papers

A new scoring system for prognostic stratification of patients with alcoholic hepatitis

Propranolol compared with propranolol plus isosorbide-5-mononitrate for portal hypertension in cirrhosis. A randomized controlled study.

Propranolol Compared with Propranolol plus Isosorbide-5-Mononitrate for Portal Hypertension in Cirrhosis

Hemodynamic and humoral changes after liver transplantation in patients with cirrhosis

Predictive value of the variceal pressure response to continued pharmacological therapy in patients with cirrhosis and portal hypertension