Development of Ascites in Compensated Cirrhosis With Severe Portal Hypertension Treated With β-Blockers

Hernández‐Gea, Virginia; Aracil, Carles; Colomo, Alan; Garupera, Isabel; Poca, María; Torras, Xavier; Miñana, Josep; Guarner, Carlos; Villanueva, Càndid

doi:10.1038/ajg.2011.456

Cited by 124 publications

(107 citation statements)

References 23 publications

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“…Several meta-analyses have confirmed survival advantage of NSBB over placebo, both before and after the occurrence of variceal bleeding 3 6. More recently, haemodynamic response to β-blockade has also been linked with a lower probability of the development of ascites, refractory ascites and hepatorenal syndrome 7 8…”

Section: Introductionmentioning

confidence: 98%

Non-selective β-blockers are associated with improved survival in patients with ascites listed for liver transplantation

Leithead

Rajoriya

Tehami

et al. 2014

Gut

168

119

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Section: Introductionmentioning

confidence: 98%

Non-selective β-blockers are associated with improved survival in patients with ascites listed for liver transplantation

Leithead

Rajoriya

Tehami

et al. 2014

Gut

168

119

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“…Furthermore, unlike EBL, NSBB have the additional benefit of reducing portal pressure. This can attenuate the development of other complications of portal hypertension such as ascites, hepatorenal syndrome, and bleeding related to portal hypertensive gastropathy (Hernandez-Gea et al 2012;Northup and Henry 2012).…”

Section: Endoscopic Band Ligationmentioning

confidence: 99%

Assessment and Management of Portal Hypertension

Abraldes¹,

Tandon²

2014

PanVascular Medicine

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Cirrhosis is the main cause of portal hypertension. Variceal bleeding is the most serious complication of portal hypertension. All cirrhotic patients should be screened endoscopically for varices which are present in about 50 % of patients at diagnosis. In patients without varices, endoscopy should be repeated every 2 years. Patients with high-risk varices (moderate or large in size, or with red color signs, or in Child-Pugh C patients) should be treated with a nonselective beta-blocker to prevent bleeding. Patients with contraindications to beta-blockers or who cannot tolerate these drugs should receive endoscopic band ligation. Acute variceal hemorrhage calls for intensive care and conservative blood transfusion policy. Treatment is based on the combined use of vasoactive drugs, endoscopic band ligation, and prophylactic antibiotics. Failures are best managed by transjugular intrahepatic portosystemic shunt. Patients surviving variceal bleeding are at high risk of rebleeding; medical therapies, using beta-blockers and endoscopic band ligation, are the recommended treatments.

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“…In a study by Hernández-Gea et al [29], 83 patients without previous decompensation but with large varices and a HPVG of >12 mmHg were treated with nadolol and a second hemodynamic study repeated in 1-3 months. Sixty-two percent of the patients had decompensation with ascites being the presenting manifestation in 81 % of these patients suggesting that a reduction of HPVG of >10 % significantly reduces the risk of developing ascites, refractory ascites, and hepatorenal syndrome in patients with compensated cirrhosis and large varices who are treated with a beta blocker.…”

Section: Other Uses Of Beta Blockers In Cirrhosismentioning

confidence: 99%

Appropriate Use of Beta Blockers in Cirrhosis

Mascarenhas

Zaman

2015

Curr Hepatology Rep

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Cirrhosis of the liver from various etiologies is a leading cause of morbidity and mortality in developing countries and industrialized nations alike. Beta blockers have been used for primary and secondary prophylaxis to prevent the initial episode of bleeding as well as rebleeding from gastroesophageal varices for several decades. However, the side effects of nonselective beta blockers preclude their use in all patients with cirrhosis. Recent evidence suggests that the use of beta blockers in patients with decompensated cirrhosis and refractory ascites may be contraindicated. The purpose of this review is to describe the appropriate use of beta blockers in cirrhosis taking into account emerging data.

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Development of Ascites in Compensated Cirrhosis With Severe Portal Hypertension Treated With β-Blockers

Abstract: In patients with compensated cirrhosis and large varices treated with β-blockers, an HVPG decrease ≥10% significantly reduces the risk of developing ascitic decompensation and other related complications such as refractory ascites or hepatorenal syndrome.

Cited by 124 publications

References 23 publications

Non-selective β-blockers are associated with improved survival in patients with ascites listed for liver transplantation

Non-selective β-blockers are associated with improved survival in patients with ascites listed for liver transplantation

Assessment and Management of Portal Hypertension

Appropriate Use of Beta Blockers in Cirrhosis

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