β-blockers in advanced cirrhosis: more friend than enemy.

β-blockers in advanced cirrhosis: more friend than enemy. Clin Mol Hepatol. 2020 Dec 03;: Authors: Yoon KT, Liu H, Lee SS Abstract 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 delet...
Source: Clinical and molecular hepatology - Category: Gastroenterology Tags: Clin Mol Hepatol Source Type: research