Management of failures of first line treatments.

Abstract : Up to 70% of the patients treated to prevent rebleeding will experience a bleeding episode within 2 years. The response should be adapted to the delay after the index bleed, the source and the severity of the haemorrhage, the underlying liver disease and the initial treatment to prevent rebleeding. Bleeding can be caused by endoscopic techniques themselves, which should incitate to complete obliteration rather than to switch to another therapy. Failure of drug therapy can be secondary to ineffectiveness, to a lack of compliance, or to an insufficient dosage. The two latter conditions may be corrected. Whenever a patient rebleeds in spite of optimal treatment, liver transplantation should be considered. When such a procedure is contra-indicated and in patients on the waiting list, a Transjugular intra-hepatic porto-systemic shunt (TIPS) should be performed.
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Article dans une revue
Digestive and Liver Disease, WB Saunders, 2008, 40 (5), pp.343-7. 〈10.1016/j.dld.2008.02.014〉
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http://www.hal.inserm.fr/inserm-00408885
Contributeur : Marie Francoise Simon <>
Soumis le : mardi 4 août 2009 - 09:13:33
Dernière modification le : jeudi 20 août 2009 - 14:40:33

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Christophe Bureau, Jean-Pierre Vinel. Management of failures of first line treatments.. Digestive and Liver Disease, WB Saunders, 2008, 40 (5), pp.343-7. 〈10.1016/j.dld.2008.02.014〉. 〈inserm-00408885〉

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