Antiviral therapy reduces rebleeding rate in patients with hepatitis B-related cirrhosis with acute variceal bleeding after endotherapy

Lingling He,Xiaohui Ye,Julong Hu,Yu Jiang,Yijun Lin,Junru Yang,Hongshan Wei,Jiali Ma,Ping Li,Xiuxia Liang,Yuling Zhou

doi:10.1186/s12876-019-1020-2

Abstract

BackgroundThe preventive effects of antiviral therapy to reduce rebleeding rate in patients with hepatitis B-related cirrhosis undergoing endoscopic treatment have not yet been reported.MethodsIn this retrospective cohort study, 1139 patients with chronic hepatitis B with first acute variceal bleeding after endoscopic therapy from September 2008 to December 2017 were included. Among them, 923 who received and 216 who did not receive antiviral therapy were followed up for rebleeding. Cumulative rebleeding rate was calculated using the Kaplan-Meier method. Univariate and multivariate logistic regression analyses were performed to estimate the effects of antiviral therapy on rebleeding risk. The propensity score matched method and inverse probability of treatment weighting analysis were used to calculate the rebleeding rate between the antiviral and non-antiviral groups.ResultsThe rebleeding rates were 40.5, 60.7, 72.6, and 89.2% in antiviral group at 1, 2, 3, and 5 years, respectively. The corresponding rebleeding rates in the non-antiviral group were 54.2, 72.4, 84.4, and 93.3%, respectively. The multivariate logistic regression analysis revealed that antiviral therapy was an independent protective factor associated with rebleeding.ConclusionAntiviral treatment significantly reduced rebleeding rate in patients with HBV-related cirrhosis who received endoscopic treatment after the first variceal bleeding.

Highlights

The preventive effects of antiviral therapy to reduce rebleeding rate in patients with hepatitis Brelated cirrhosis undergoing endoscopic treatment have not yet been reported
Acute gastroesophageal variceal bleeding is a major complication of cirrhosis that leads to a high mortality rate (40%) and rebleeding rate (60% of survivors) [10, He et al BMC Gastroenterology (2019) 19:101
After excluding patients with recurrent acute variceal bleeding (n = 1917), who received endoscopic treatment to prevent bleeding (n = 31), who were lost to follow-up (n = 92), the final analysis consecutively included 1139 patients with chronic hepatitis B (CHB) with first occurrence of acute variceal bleeding and received endoscopic hemostasis

Summary

Introduction

The preventive effects of antiviral therapy to reduce rebleeding rate in patients with hepatitis Brelated cirrhosis undergoing endoscopic treatment have not yet been reported. Acute gastroesophageal variceal bleeding is a major complication of cirrhosis that leads to a high mortality rate (40%) and rebleeding rate (60% of survivors) [10, He et al BMC Gastroenterology (2019) 19:101. Several drugs were used to improve portal hypertension, in which non-selective beta-blockers (NSBBs) remained the cornerstone, albeit carvedilol seemed more effective in decreasing portal pressure [15, 16]. These drugs were all scrutinized in patients with severe or advanced cirrhosis [16]

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Discussion

Conclusion