New Delhi, May 27: A new treatment demonstrated by doctors in Calcutta may reduce the risk of bleeding in patients with portal hypertension, a symptom of liver cirrhosis.

Doctors at the Medical College and Hospital, Calcutta, have shown that an old drug called spironolactone can reduce portal hypertension, an increase in the blood pressure in the veins leading into the liver.

Portal hypertension can cause life-threatening bleeding from the veins in the oesophagus. The primary treatment prescribed today is a drug called propranolol, but only one in three patients appears to benefit from this treatment. About 70 per cent of patients whose bleeding has been controlled bleed again within a year.

Now, Binay De and his colleagues at the medical college have shown that a combination of spironolactone and propranolol is better at reducing the pressure in the veins than propanolol alone.

Spironolactone has long been used by doctors to treat a complication of liver cirrhosis called ascites in which excess fluid accumulates in the abdomen. The drug accelerates excretion of water.

“Spironolactone has an independent effect on portal hypertension,” De said. “Although spironolactone has been prescribed for patients with cirrhosis and ascites for years, its effect on portal hypertension had not been evident until now,” De said.

In their study, the researchers found that 14 out of 18 patients with cirrhosis who received the spironolactone-propranolol combination had a 20 per cent portal vein pressure reduction, compared to only 6 out of 17 cirrhosis patients who were given propranolol alone.

Spironolactone’s pressure-reducing action is likely to result from a direct effect on the wall of the blood vessel and its ability to reduce blood volume, De said. Reducing pressure will reduce the risk of bleeding.

“A greater number of patients may be protected by this combination therapy than by propranolol alone,” the researchers have written in a recent research paper in the World Journal of Gastroenterology.

“This is a new finding,” said Jayanta Mukherjee, a gastroenterologist in Calcutta who was not part of the study. “Spironolactone is already being used to treat ascites, so this will mainly benefit patients who have portal hypertension, but no ascites who were not likely to be prescribed spironolactone earlier,” he said.