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Nonselective beta-adrenergic blocker (NSBB) therapy for the prevention of initial and recurrent gastrointestinal bleeding in cirrhotic patients with gastroesophageal varices have been used for the past four decades. They are considered the treatment cornerstone for varices and have become the standard of care. However, a 2010 study from the group that pioneered β-blocker therapy suggested a detrimental effect of NSBBs in decompensated cirrhosis, especially in patients with refractory ascites. Since then, numerous additional studies have incompletely resolved whether NSBBs are deleterious, although more recent evidence weighs against a harmful effect. The possibility of a 'therapeutic window' has also been raised. We aimed to review the literature to analyze the pros and cons of NSBBs in patients with cirrhosis, not only with respect to bleeding/mortality but other potential benefits and risks. β-blockers are highly effective to prevent first bleeding and recurrent bleeding. Furthermore, NSBBs improve congestion/ischemia of the gut mucosa, decrease intestinal permeability, and therefore indirectly alleviate systemic inflammation. β-blockers shorten the electrocardiographic prolonged QTc interval and also may decrease the incidence of hepatocellular carcinoma. On the other hand, the possibility of deleterious effects in cirrhosis has not been completely eliminated. NSBBs may be associated with an increased risk of portal vein thrombosis, although this could be correlational artefact. Overall, we conclude that β-blockers in cirrhosis are much more friend than enemy.


Ki Tae Yoon, Hongqun Liu, Samuel S Lee. β-blockers in advanced cirrhosis: more friend than enemy. Clinical and molecular hepatology. 2020 Dec 03

PMID: 33317244

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