Use of non-selective beta blockers in cirrhosis: The evidence we need before closing (or not) the window

Vincenzo La Mura, Giulia Tosetti, Massimo Primignani, Francesco Salerno

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Non selective beta blockers (NSBBs) are used in primary and secondary prophylaxis of portal hypertensionrelated bleeding in patients with cirrhosis. The efficacy of NSBBs treatment is predicted by hemodynamic response in term of reduction of the hepatic venous pressure gradient (HVPG) below 12 mmHg or at least 20% of the basal value. Nevertheless a relevant number of patients who do not achieve this HVPG reduction during NSBBs therapy do not bleed during follow up; this evidence suggests an additional non-hemodynamic advantage of NSBBs treatment to modify the natural history of cirrhosis. Recent studies have questioned the efficacy and safety of NSBBs in patients with advanced stage of liver disease characterized by refractory ascites and/or spontaneous bacterial peritonitis. These studies have suggested the existence of a defined and limited period to modify the natural history of cirrhosis by NSBBs: the "window hypothesis". According with this hypothesis, patients with cirrhosis benefit from the use of NSBBs from the appearance of varices up to the development of an advanced stage of cirrhosis. Indeed, in patients with refractory ascites and/or spontaneous bacterial peritonitis the hemodynamic effects of NSBBs may expose to a high risk of further complications such as renal insufficiency and/or death. Methodological concerns and contrasting results counterbalance the evidence produced up to now on this issue and are the main topic of this editorial.

Original languageEnglish
Pages (from-to)2265-2268
Number of pages4
JournalWorld Journal of Gastroenterology
Volume21
Issue number8
DOIs
Publication statusPublished - Feb 28 2015

Fingerprint

Fibrosis
Venous Pressure
Peritonitis
Ascites
Hemodynamics
Liver
Varicose Veins
Renal Insufficiency
Liver Diseases
Therapeutics
Hemorrhage
Safety

Keywords

  • Bleeding prophylaxis
  • Cirrhosis
  • End stage liver disease
  • Non-selective beta blockers
  • Portal hypertension

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Use of non-selective beta blockers in cirrhosis : The evidence we need before closing (or not) the window. / La Mura, Vincenzo; Tosetti, Giulia; Primignani, Massimo; Salerno, Francesco.

In: World Journal of Gastroenterology, Vol. 21, No. 8, 28.02.2015, p. 2265-2268.

Research output: Contribution to journalArticle

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