caa a22 4500 445797789 CHVBK 20180317145131.0 cr unu---uuuuu 170323e20111101xx s 000 0 eng 10.1007/s10620-011-1749-0 doi (NATIONALLICENCE)springer-10.1007/s10620-011-1749-0 Adherence and Adequacy of Therapy for Esophageal Varices Prophylaxis [Elektronische Daten] [Haripriya Maddur, Suraj Naik, Ali Siddiqui, Don Rockey] Aims: Esophageal varices (EVs) are prevalent among cirrhotics and their bleeding leads to substantial morbidity and mortality. Management guidelines available during this study recommended beta-blocker therapy for primary prophylaxis and beta-blocker or band ligation (EVL) for secondary prophylaxis. We evaluated prophylaxis practice patterns. Methods: We performed a retrospective cohort study of in and outpatient cirrhotics with known EVs at two University of Texas Southwestern teaching institutions. Use of prophylactic therapy and its adequacy (defined using published guidelines) was measured. Results: A total of 419 patients with cirrhosis and EVs warranting prophylaxis were identified, including 276 inpatients and 143 outpatients. Of those admitted with a first bleed (i.e. eligible for primary prophylactic therapy), 30/104 (29%) were on beta blocker. In this group, only 3/104 (3%) received optimal therapy (heart rate <55). Among inpatients with a previous EV bleed, 120/172 (70%) were on a beta blocker or had undergone EVL, although only 66/172 (38%) received optimal therapy. In the inpatient cohort, ten patients died of gastrointestinal hemorrhage, three of whom were receiving optimal therapy. Among outpatients, 94/121 (78%) without previous bleeding received primary prophylaxis and 20/22 (91%) of those with previous bleeding received some form of secondary prophylaxis. However, only 11 (9%) received adequate primary prophylaxis therapy, while 9 (41%) received appropriate secondary prophylaxis. Conclusions: Prophylaxis intent appears to be greatly improved compared to previous reports. However, implementation of optimal therapy appeared to be suboptimal. We conclude that efforts need to be made to ensure optimal treatment. Springer Science+Business Media, LLC, 2011 Cirrhosis nationallicence Gastrointestinal hemorrhage nationallicence Band ligation nationallicence Beta-blockers nationallicence Maddur Haripriya Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., 75390-8887, Dallas, TX, USA aut Naik Suraj Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., 75390-8887, Dallas, TX, USA aut Siddiqui Ali Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., 75390-8887, Dallas, TX, USA aut Rockey Don Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., 75390-8887, Dallas, TX, USA aut Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/11(2011-11-01), 3129-3136 0163-2116 56:11<3129 2011 56 10620 https://doi.org/10.1007/s10620-011-1749-0 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10620-011-1749-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Maddur Haripriya Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., 75390-8887, Dallas, TX, USA aut NATIONALLICENCE 700 1- Naik Suraj Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., 75390-8887, Dallas, TX, USA aut NATIONALLICENCE 700 1- Siddiqui Ali Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., 75390-8887, Dallas, TX, USA aut NATIONALLICENCE 700 1- Rockey Don Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., 75390-8887, Dallas, TX, USA aut NATIONALLICENCE 773 0- Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/11(2011-11-01), 3129-3136 0163-2116 56:11<3129 2011 56 10620 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer