Beta-blockers in Liver Cirrhosis

Overview

Journal Ann Gastroenterol

Specialty Gastroenterology

Date 2014 Apr 10

PMID 24714633

Citations 9

Authors

Valerio Giannelli

Barbara Lattanzi

Ulrich Thalheimer

Manuela Merli

Affiliations

Soon will be listed here.

Abstract

Since the original description of the effectiveness of β-blockers in lowering the portal pressure and therefore the risk of variceal bleeding, more than 500 articles in the English literature on the use of non selective β-blockers (NSBB) in cirrhosis have been published. The use of NSBB in pre-primary prophylaxis of variceal bleeding is currently not indicated. In primary prophylaxis, patients with high risk small varices or large/medium varices should receive primary prophylaxis either with NSBB or with endoscopic band ligation if there are contraindications to NSBB. For secondary prophylaxis the current recommendation is to receive a combination of NSBB and endoscopic variceal ligation. In addition to lowering portal pressure, NSBB can also reduce bacterial translocation, potentially exerting multiple beneficial effects which go beyond the reduction of bleeding risk. Carvedilol is a NSBB with intrinsic anti-α(1)-adrenergic activity, possibly more effective than propranolol in lowering portal hypertension. A potential harmful effect of propranolol in patients with cirrhosis with refractory ascites deserves further confirmation. NSBB remain the cornerstone of therapy in cirrhotic patients with portal hypertension.

Citing Articles

Sociodemographic and medical characteristics of liver cirrhosis deaths in a Ghanaian tertiary hospital.

Agbozo W, Dzudzor B, Nyarko E, Lartey-Abrahams K, Mensah R, Tachi K Ghana Med J. 2023; 56(4):259-267.

PMID: 37575631 PMC: 10416286. DOI: 10.4314/gmj.v56i4.4.

Nonselective beta-blocker use is associated with increased hepatic encephalopathy-related readmissions in cirrhosis.

Fallahzadeh M, Asrani S, Tapper E, Saracino G, Rahimi R World J Clin Cases. 2022; 10(23):8097-8106.

PMID: 36159543 PMC: 9403687. DOI: 10.12998/wjcc.v10.i23.8097.

Propranolol plus endoscopic ligation for variceal bleeding in patients with significant ascites: Propensity score matching analysis.

Yoo J, Kim S, Kim Y, Lee B, Jeong S, Jang J Medicine (Baltimore). 2020; 99(5):e18913.

PMID: 32000397 PMC: 7004788. DOI: 10.1097/MD.0000000000018913.

Changes in transient elastography in early cirrhotic patients after receiving nonselective B-blocker for primary variceal bleeding prophylaxis: Three-month follow up.

Piyachaturawat P, Siramolpiwat S, Sonsiri K, Tangkijvanich P, Treeprasertsuk S JGH Open. 2018; 2(5):172-177.

PMID: 30483585 PMC: 6206988. DOI: 10.1002/jgh3.12063.

Rifaximin and Propranolol Combination Therapy Is More Effective than Propranolol Monotherapy for the Reduction of Portal Pressure: An Open Randomized Controlled Pilot Study.

Lim Y, Kim M, Jang Y, Baik S, Kwon S Gut Liver. 2017; 11(5):702-710.

PMID: 28651304 PMC: 5593333. DOI: 10.5009/gnl16478.

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