***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Because several studies have suggested that beta blockers are effective in the prophylaxis of first variceal bleeding in cirrhosis , screening for oesophageal varices might be appropriate . We prospect ively studied 84 cirrhotic patients without obvious evidence of large oesophageal varices and previous bleeding during a mean follow up of 16 months . At entry to the study 41 patients had no oesophageal varices and in 43 these were grade 1 . The subsequent percentages of patients without large oesophageal varices were 74 % at one year and 52 % at two years . Univariate analysis showed that a longer duration of cirrhosis ( p less than 0.05 ) and grade 1 oesophageal varices at entry ( p less than 0.001 ) were predictive factors for the occurrence of large oesophageal varices , whereas , multivariate analysis showed that the initial size of the oesophageal varices ( p less than 0.001 ) , a high initial Child-Pugh score , and a smaller improvement in Child-Pugh score during the study were independent risk factors . Among patients with grade s 0 and 1 oesophageal varices at the start of the study the proportions with large oesophageal varices at two years were 31 % and 70 % respectively . We have calculated that , accepting a maximum risk of first bleeding of 10 % without prophylactic treatment , a patient without oesophageal varices should be screened endoscopically every other year , while a patient with grade 1 disease should benefit from one annual upper gastrointestinal endoscopy Background and aims : Risk factors for mortality and re-bleeding following acute variceal haemorrhage ( AVH ) are incompletely understood . The aim of this study was to determine risk factors for 6-week mortality , and re-bleeding within 5 days in patients with cirrhosis and AVH . Methods : Kaplan – Meier and Cox proportional hazards regression analyses were used to determine risk factors among 256 patients with AVH entered into a r and omised , prospect i ve trial . Results : Thirty-five patients ( 14 % ) died within 6 weeks of AVH ; 14 deaths ( 40 % ) occurred within 5 days . Only the Model for End-stage Liver Disease ( MELD ) score and units of packed red blood cells ( PRBCs ) transfused in the first 24 h were associated with 6-week mortality univariately ( HR 1.11 , p<0.001 ; HR 1.22 , p<0.001 ) and bivariately ( HR MELD = 1.10 , p<0.001 ; HR per unit of PRBCs transfused = 1.15 , p = 0.005 ) . Re-bleeding within 5 days occurred in 37 patients ( 15 % ) ; MELD score ( p = 0.01 ) and a clot on a varix ( p = 0.05 ) predicted re-bleeding . Patients with a MELD score ⩾18 ; both MELD score ⩾18 and ⩾4 units of PRBCs transfused ; both MELD score ⩾18 and active bleeding at index endoscopy ; and variceal re-bleeding had increased risk of death 6 weeks post-AVH ( HR = 7.4 , p<0.001 ; 11.3 , p<0.001 ; 9.9 , p<0.001 ; 10.2 , p<0.001 respectively ) . Conclusions : Patients with AVH and MELD score ⩾18 , requiring ⩾4 units of PRBCs within the first 24 h or with active bleeding at endoscopy are at increased risk of dying within 6 weeks . MELD score ⩾18 is also a strong predictor of variceal re-bleeding within the first 5 days Background Endoscopy ( esophagogastroduodenoscopy , EGD ) to screen for esophageal varices ( EV ) is recommended in patients with portal hypertension . Reports indicate that capsule endoscopy ( CE ) is capable of identifying large/medium varices ( L/MV ) when the varix comprises more than 25 % of the circumference of the field of view . Aims We evaluated the ability of CE to discriminate the size of EV using this grading scale . Methods Patients underwent CE and EGD on the same day . A blinded investigator interpreted capsule findings . CE labeled EV as L/MV if ≥25 % of the lumen circumference was occupied , and small/none for < 25 % . Results A total of 37 patients were enrolled in this prospect i ve , observational study at a single tertiary-care academic center . Three CE were excluded due to rapid esophageal transit time or technical malfunction . Using a 25 % threshold , the sensitivity , specificity , positive predictive value ( PPV ) , and negative predictive value ( NPV ) for EC to discriminate L/MV were 23.5 % , 88.2 % , 66.7 % , and 53.6 % , respectively ( κ = 0.12 ) . Reducing the threshold to 12.5 % result ed in sensitivity , specificity , PPV , and NPV of 88.2 % , 64.7 % , 71.4 % , and 84.6 % , respectively ( κ = 0.53 ) . A receiver-operator characteristic ( ROC ) curve showed a 15 % threshold to be optimal in discriminating EV size using CE , result ing in sensitivity , specificity , PPV , and NPV of 76.5 % , 82.4 % , 81.3 % , and 77.8 % , respectively ( κ = 0.59 ) . Conclusions This study indicates that discriminating EV size by the current capsule scale is unreliable . Lowering the grading threshold improved the ability to discriminate EV size by CE . In the proper context , CE is an alternative to EGD to screen for EV AIM To investigate the utility of esophageal capsule endoscopy in the diagnosis and grading of esophageal varices . METHODS Cirrhotic patients who were undergoing esophagogastroduodenoscopy ( EGD ) for variceal screening or surveillance underwent capsule endoscopy .  Two separate blinded investigators read each capsule endoscopy for the following results : variceal grade , need for treatment with variceal b and ing or prophylaxis with beta-blocker therapy , degree of portal hypertensive gastropathy , and gastric varices . RESULTS Fifty patients underwent both capsule and EGD .  Forty-eight patients had both procedures on the same day , and 2 patients had capsule endoscopy within 72 h of EGD . The accuracy of capsule endoscopy to decide on the need for prophylaxis was 74 % , with sensitivity of 63 % and specificity of 82 % . Inter-rater agreement was moderate ( kappa = 0.56 ) . Agreement between EGD and capsule endoscopy on grade of varices was 0.53 ( moderate ) . Inter-rater reliability was good ( kappa = 0.77 ) . In diagnosis of portal hypertensive gastropathy , accuracy was 57 % , with sensitivity of 96 % and specificity of 17 % . Two patients had gastric varices seen on EGD , one of which was seen on capsule endoscopy . There were no complications from capsule endoscopy . CONCLUSION We conclude that capsule endoscopy has a limited role in deciding which patients would benefit from EGD with b and ing or beta-blocker therapy . More data is needed to assess accuracy for staging esophageal varices , PHG , and the detection of gastric varices BACKGROUND Nonselective beta-adrenergic blockers decrease portal pressure and prevent variceal hemorrhage . Their effectiveness in preventing varices is unknown . METHODS We r and omly assigned 213 patients with cirrhosis and portal hypertension ( minimal hepatic venous pressure gradient [ HVPG ] of 6 mm Hg ) to receive  timolol , a nonselective beta-blocker  ( 108 patients ) , or  placebo ( 105 patients ) . The primary end point was the development of gastroesophageal varices or variceal hemorrhage . Endoscopy and HVPG measurements were repeated yearly . RESULTS During a median follow-up of 54.9 months , the rate of the primary end point did not differ significantly between the timolol group and the placebo group ( 39 percent and 40 percent , respectively ; P=0.89 ) , nor were there significant differences in the rates of ascites , encephalopathy , liver transplantation , or death . Serious adverse events were more common among patients in the timolol group than among those in the placebo group ( 18 percent vs. 6 percent , P=0.006 ) . Varices developed less frequently among patients with a baseline HVPG of less than 10 mm Hg and among those in whom the HVPG decreased by more than 10 percent at one year and more frequently among those in whom the HVPG increased by more than 10 percent at one year . CONCLUSIONS Nonselective beta-blockers are ineffective in preventing varices in unselected patients with cirrhosis and portal hypertension and are associated with an increased number of adverse events . ( Clinical Trials.gov number , NCT00006398 . Several treatments have been proven to be effective for variceal bleeding in patients with cirrhosis . The aim of this multicenter , prospect i ve , cohort study was to assess how these treatments are used in clinical practice and what are the posttherapeutic prognosis and prognostic indicators of upper digestive bleeding in patients with cirrhosis . A training set of 291 and a test set of 174 bleeding cirrhotic patients were included . Treatment was according to the preferences of each center and the follow-up period was 6 weeks . Predictive rules for 5-day failure ( uncontrolled bleeding , rebleeding , or death ) and 6-week mortality were developed by the logistic model in the training set and vali date d in the test set . Initial treatment controlled bleeding in 90 % of patients , including vasoactive drugs in 27 % , endoscopic therapy in 10 % , combined ( endoscopic and vasoactive ) in 45 % , balloon tamponade alone in 1 % , and none in 17 % . The 5-day failure rate was 13 % , 6-week rebleeding was 17 % , and mortality was 20 % . Corresponding findings for variceal versus nonvariceal bleeding were 15 % versus 7 % ( P = .034 ) , 19 % versus 10 % ( P = .019 ) , and 20 % versus 15 % ( P = .22 ) . Active bleeding on endoscopy , hematocrit levels , aminotransferase levels , Child-Pugh class , and portal vein thrombosis were significant predictors of 5-day failure ; alcohol-induced etiology , bilirubin , albumin , encephalopathy , and hepatocarcinoma were predictors of 6-week mortality . Prognostic re assessment including blood transfusions improved the predictive accuracy . All the developed prognostic models were superior to the Child-Pugh score . In conclusion , prognosis of digestive bleeding in cirrhosis has much improved over the past 2 decades . Initial treatment stops bleeding in 90 % of patients . Accurate predictive rules are provided for early recognition of high-risk patients OBJECTIVES To analyze sources search ed in Cochrane review s , to determine the proportion of trials included in review s that are indexed in major data bases , and to compare the quality of these trials with those from other sources . METHODS All new systematic review s in the Cochrane Library , Issue1 2001 , that were restricted to r and omized controlled trials ( RCTs ) or quasi- RCTs were selected . The sources search ed in the review s were recorded , and the trials included were checked to see whether they were indexed in four major data bases . Trials not indexed were checked to determine how they could be identified . The quality of trials found in major data bases was compared with those found from other sources . RESULTS The range in the number of data bases search ed per review ranged between one and twenty-seven . The proportion of the trials in the four data bases were Cochrane Controlled Trials Register = 78.5 % , MEDLINE = 68.8 % , Embase = 65.0 % , and Science/Social Sciences Citation Index = 60.7 % . Search ing another twenty-six data bases after Cochrane Controlled Trials Register ( CCTR ) , MEDLINE , and Embase only found 2.4 % additional trials . There was no significant difference between trials found in the CCTR , MEDLINE , and Embase compared with other trials , with respect to adequate allocation concealment or sample size . CONCLUSIONS There was a large variation between review s in the exhaustiveness of the literature search es . CCTR was the single best source of RCTs . Additional data base search ing retrieved only a small percentage of extra trials . Contacting authors and manufacturers to find unpublished trials appeared to be a more effective method of obtaining the additional better quality trials BACKGROUND / AIMS The incidence and natural history of small esophageal varices ( EV ) in cirrhotics may influence the frequency of endoscopies and the decision to start a pharmacological treatment in these patients . METHODS We prospect ively evaluated 206 cirrhotics , 113 without varices and 93 with small EV , during a mean follow-up of 37+/-22 months . Patients with previous gastrointestinal bleeding or receiving any treatment for portal hypertension were excluded .  Endoscopy was performed every 12 months . RESULTS The rate 
    Output:
    
We can not support the use of capsule endoscopy as a triage test in adults with cirrhosis , administered before oesophago-gastro-duodenoscopy , despite the low incidence of adverse events and participant reports of being better tolerated .
Thus , we can not conclude that oesophago-gastro-duodenoscopy can be replaced by capsule endoscopy for the detection of oesophageal varices in adults with cirrhosis .
We found no data assessing capsule endoscopy in children and in people with portal thrombosis