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Perceptions on the management of varices and on the use of albumin in patients with cirrhosis among GI specialists in Austria

BACKGROUND: Portal hypertension (PH) causes severe complications in patients with liver cirrhosis, such as variceal bleeding and ascites; however, data on the knowledge and perceptions on guideline recommendations for the management of varices and the use of albumin is scarce. METHODS: We designed t...

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Autores principales: Pfisterer, Nikolaus, Schmidbauer, Caroline, Riedl, Florian, Maieron, Andreas, Stadlbauer, Vanessa, Hennlich, Barbara, Schwarzer, Remy, Puespoek, Andreas, Bucsics, Theresa, Effenberger, Maria, Bota, Simona, Gschwantler, Michael, Peck-Radosavljevic, Markus, Mandorfer, Mattias, Madl, Christian, Trauner, Michael, Reiberger, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116244/
https://www.ncbi.nlm.nih.gov/pubmed/33270161
http://dx.doi.org/10.1007/s00508-020-01769-9
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author Pfisterer, Nikolaus
Schmidbauer, Caroline
Riedl, Florian
Maieron, Andreas
Stadlbauer, Vanessa
Hennlich, Barbara
Schwarzer, Remy
Puespoek, Andreas
Bucsics, Theresa
Effenberger, Maria
Bota, Simona
Gschwantler, Michael
Peck-Radosavljevic, Markus
Mandorfer, Mattias
Madl, Christian
Trauner, Michael
Reiberger, Thomas
author_facet Pfisterer, Nikolaus
Schmidbauer, Caroline
Riedl, Florian
Maieron, Andreas
Stadlbauer, Vanessa
Hennlich, Barbara
Schwarzer, Remy
Puespoek, Andreas
Bucsics, Theresa
Effenberger, Maria
Bota, Simona
Gschwantler, Michael
Peck-Radosavljevic, Markus
Mandorfer, Mattias
Madl, Christian
Trauner, Michael
Reiberger, Thomas
author_sort Pfisterer, Nikolaus
collection PubMed
description BACKGROUND: Portal hypertension (PH) causes severe complications in patients with liver cirrhosis, such as variceal bleeding and ascites; however, data on the knowledge and perceptions on guideline recommendations for the management of varices and the use of albumin is scarce. METHODS: We designed two structured surveys on (i) the management of varices and (ii) the use of albumin for Austrian physicians of specialized Gastro-Intestinal (GI) centers. The interviewed physicians were confronted spontaneously and provided ad hoc responses to the questionnaire. RESULTS: In total, 158 surveys were completed. Interestingly, many specialists (30%) would recommend a follow-up gastroscopy after 1 year in patients with compensated cirrhosis without varices (i.e., overtreatment). For small varices, 81.5% would use non-selective beta blockers (NSBB) for primary prophylaxis (PP). For PP in patients with large varices, endoscopic band ligation (EBL) plus NSBB was preferred by 51.4% (i.e., overtreatment). Knowledge on the indication criteria for early TIPS (transjugular intrahepatic portosystemic shunt) was reported by 54.3%, but only 20% could report these criteria correctly. The majority (87.1%) correctly indicated a preference to use NSBB and EBL for secondary prophylaxis (SP). The majority of participating gastroenterologists reported no restrictions on the use of albumin (89.8%) in their hospitals. Of the interviewed specialists, 63.6% would use albumin in patients with SBP; however, only 11.4% would use the doses recommended by guidelines. The majority of specialists indicated using albumin at the recommended doses for hepatorenal syndrome (HRS-AKI, 86.4%) and for large volume paracentesis (LVP, 73.3%). The individual responses regarding albumin use for infections/sepsis, hyponatremia, renal impairment, and encephalopathy were heterogeneous. CONCLUSION: The reported management of PH and varices is mostly adherent to guidelines, but endoscopic surveillance in patients without varices is too intense and EBL is overused in the setting of PP. Knowledge on the correct use of early TIPS must be improved among Austrian specialists. Albumin use is widely unrestricted in Austria; however, albumin is often underdosed in established indications. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00508-020-01769-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-81162442021-05-13 Perceptions on the management of varices and on the use of albumin in patients with cirrhosis among GI specialists in Austria Pfisterer, Nikolaus Schmidbauer, Caroline Riedl, Florian Maieron, Andreas Stadlbauer, Vanessa Hennlich, Barbara Schwarzer, Remy Puespoek, Andreas Bucsics, Theresa Effenberger, Maria Bota, Simona Gschwantler, Michael Peck-Radosavljevic, Markus Mandorfer, Mattias Madl, Christian Trauner, Michael Reiberger, Thomas Wien Klin Wochenschr Original Article BACKGROUND: Portal hypertension (PH) causes severe complications in patients with liver cirrhosis, such as variceal bleeding and ascites; however, data on the knowledge and perceptions on guideline recommendations for the management of varices and the use of albumin is scarce. METHODS: We designed two structured surveys on (i) the management of varices and (ii) the use of albumin for Austrian physicians of specialized Gastro-Intestinal (GI) centers. The interviewed physicians were confronted spontaneously and provided ad hoc responses to the questionnaire. RESULTS: In total, 158 surveys were completed. Interestingly, many specialists (30%) would recommend a follow-up gastroscopy after 1 year in patients with compensated cirrhosis without varices (i.e., overtreatment). For small varices, 81.5% would use non-selective beta blockers (NSBB) for primary prophylaxis (PP). For PP in patients with large varices, endoscopic band ligation (EBL) plus NSBB was preferred by 51.4% (i.e., overtreatment). Knowledge on the indication criteria for early TIPS (transjugular intrahepatic portosystemic shunt) was reported by 54.3%, but only 20% could report these criteria correctly. The majority (87.1%) correctly indicated a preference to use NSBB and EBL for secondary prophylaxis (SP). The majority of participating gastroenterologists reported no restrictions on the use of albumin (89.8%) in their hospitals. Of the interviewed specialists, 63.6% would use albumin in patients with SBP; however, only 11.4% would use the doses recommended by guidelines. The majority of specialists indicated using albumin at the recommended doses for hepatorenal syndrome (HRS-AKI, 86.4%) and for large volume paracentesis (LVP, 73.3%). The individual responses regarding albumin use for infections/sepsis, hyponatremia, renal impairment, and encephalopathy were heterogeneous. CONCLUSION: The reported management of PH and varices is mostly adherent to guidelines, but endoscopic surveillance in patients without varices is too intense and EBL is overused in the setting of PP. Knowledge on the correct use of early TIPS must be improved among Austrian specialists. Albumin use is widely unrestricted in Austria; however, albumin is often underdosed in established indications. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00508-020-01769-9) contains supplementary material, which is available to authorized users. Springer Vienna 2020-12-03 2021 /pmc/articles/PMC8116244/ /pubmed/33270161 http://dx.doi.org/10.1007/s00508-020-01769-9 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Pfisterer, Nikolaus
Schmidbauer, Caroline
Riedl, Florian
Maieron, Andreas
Stadlbauer, Vanessa
Hennlich, Barbara
Schwarzer, Remy
Puespoek, Andreas
Bucsics, Theresa
Effenberger, Maria
Bota, Simona
Gschwantler, Michael
Peck-Radosavljevic, Markus
Mandorfer, Mattias
Madl, Christian
Trauner, Michael
Reiberger, Thomas
Perceptions on the management of varices and on the use of albumin in patients with cirrhosis among GI specialists in Austria
title Perceptions on the management of varices and on the use of albumin in patients with cirrhosis among GI specialists in Austria
title_full Perceptions on the management of varices and on the use of albumin in patients with cirrhosis among GI specialists in Austria
title_fullStr Perceptions on the management of varices and on the use of albumin in patients with cirrhosis among GI specialists in Austria
title_full_unstemmed Perceptions on the management of varices and on the use of albumin in patients with cirrhosis among GI specialists in Austria
title_short Perceptions on the management of varices and on the use of albumin in patients with cirrhosis among GI specialists in Austria
title_sort perceptions on the management of varices and on the use of albumin in patients with cirrhosis among gi specialists in austria
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116244/
https://www.ncbi.nlm.nih.gov/pubmed/33270161
http://dx.doi.org/10.1007/s00508-020-01769-9
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