Open AccessPrimary Prophylaxis of Variceal Hemorrhage in Children With Portal Hypertension: A Framework for Future Research
Author(s) -
Ling Simon C,
Walters Thomas,
McKiernan Patrick J,
Schwarz Kathleen B,
GarciaTsao Guadalupe,
Shneider Benjamin L
Publication year - 2011
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0b013e318205993a
Subject(s) - medicine , portal hypertension , varices , ligation , natural history , randomized controlled trial , dosing , clinical trial , varix , intensive care medicine , incidence (geometry) , medline , cirrhosis , pediatrics , physics , political science , law , optics
Nonselective β‐blocker therapy and endoscopic variceal ligation reduce the incidence of variceal hemorrhage in cirrhotic adults, but their use in children is controversial. There are no evidence‐based recommendations for the prophylactic management of children at risk of variceal hemorrhage due to the lack of appropriate randomized controlled trials. In a recent gathering of experts at the American Association for the Study of Liver Diseases annual meeting, significant challenges were identified in attempting to design and implement a clinical trial of primary prophylaxis in children using either of these therapies. These challenges render such a trial unfeasible, primarily due to the large sample size required, inadequate knowledge of appropriate dosing of β‐blockers, and difficulty in recruiting to a trial of endoscopic variceal ligation. Pediatric research should focus on addressing questions of natural history and diagnosis of varices, prediction of variceal bleeding, optimal approaches to β‐blocker and ligation therapy, and alternative study designs to explore therapeutic efficacy in children.