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https://www.readbyqxmd.com/read/27864004/beta-adrenergic-blockade-and-decompensated-cirrhosis
#1
REVIEW
Thomas Reiberger, Mattias Mandorfer
Non-selective betablockers (NSBBs) remain the cornerstone of medical treatment of portal hypertension. The evidence for their efficacy to prevent variceal bleeding is derived from prospective trials, which largely excluded patients with refractory ascites and renal failure. In parallel to the increasing knowledge on portal hypertension-induced changes in systemic hemodynamics, cardiac function, and renal perfusion, emerging studies have raised concerns about harmful effects of NSBBs. Clinicians are facing an ongoing controversy on the use of NSBBs in patients with advanced cirrhosis...
November 15, 2016: Journal of Hepatology
https://www.readbyqxmd.com/read/27746613/hemodynamic-response-to-carvedilol-is-maintained-for-long-periods-and-leads-to-better-clinical-outcome-in-cirrhosis-a-prospective-study
#2
Vijendra Kirnake, Anil Arora, Varun Gupta, Praveen Sharma, Vikas Singla, Naresh Bansal, Mohan Goyal, Romesh Chawlani, Ashish Kumar
BACKGROUND: Non-selective beta-blockers (NSBBs), e.g. propranolol, are recommended for prophylaxis of variceal bleeding in cirrhosis. Carvedilol, a newer NSBB with additional anti-α1-adrenergic activity, is superior to propranolol in reducing portal pressure. Repeated HVPG measurements are required to identify responders to NSBB. We aimed to determine whether a single-time HVPG measurement, using acute-hemodynamic-response-testing, is sufficient to predict long-term response to carvedilol, and whether these responders have better clinical outcome...
September 2016: Journal of Clinical and Experimental Hepatology
https://www.readbyqxmd.com/read/27717792/beta-blockers-and-cirrhosis-2016
#3
Mattias Mandorfer, Thomas Reiberger
To date, non-selective beta blockers (NSBBs) are a cornerstone in the treatment of portal hypertension. During the last years, our understanding of the potential benefits of early initiation of NSBB treatment, their effects beyond the prevention of variceal bleeding (i.e., their non-hemodyamic effects), as well as potential detrimental effects in patients with advanced disease has continuously evolved. In addition, we have learned that not all NSBBs are equal. Due to its additional anti-α1-adrenergic activity, carvedilol has been shown to be more potent in decreasing portal pressure, but might lead to more pronounced decreases in systemic arterial pressure, when compared to conventional NSBBs...
September 27, 2016: Digestive and Liver Disease
https://www.readbyqxmd.com/read/27670600/risk-and-predictors-of-variceal-bleeding-in-cirrhosis-patients-receiving-primary-prophylaxis-with-non-selective-beta-blockers
#4
Richa Shukla, Jennifer Kramer, Yumei Cao, Jun Ying, Aylin Tansel, Annette Walder, Shailesh Advani, Hashem B El-Serag, Fasiha Kanwal
OBJECTIVES: Prior studies have demonstrated the efficacy of non-selective beta-blockers (NSBB) in preventing first variceal bleeding in patients with cirrhosis. However, little is known about the overall effectiveness of NSBB in routine clinical care. METHODS: We conducted a retrospective cohort study of cirrhotic patients without prior bleeding who initiated a NSBB (propranolol, nadolol) at any Veterans Administration facility between 2008 and 2013. The primary outcome was variceal bleeding within 12 months...
September 27, 2016: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/27648153/rethinking-the-role-of-non-selective-beta-blockers-in-patients-with-cirrhosis-and-portal-hypertension
#5
REVIEW
Alberto Ferrarese, Alberto Zanetto, Giacomo Germani, Patrizia Burra, Marco Senzolo
Non-selective beta blockers (NSBB) are commonly used to prevent portal hypertensive bleeding in cirrhotics. Nevertheless, in the last years, the use of NSBB in critically decompensated patients, especially in those with refractory ascites, has been questioned, mainly for an increased risk of mortality and worsening of systemic hemodynamics. Moreover, even if NSBB have been reported to correlate with a higher risk of renal failure and severe infection in patients with advanced liver disease and hypotension, their use has been associated with a reduction of risk of spontaneous bacterial peritonitis, modification of gut permeability and reduction of bacterial translocation...
August 28, 2016: World Journal of Hepatology
https://www.readbyqxmd.com/read/27185358/the-accuracy-of-spleen-stiffness-measurement-to-predict-varices-in-chronic-hepatitis-b-cirrhotic-patients-with-or-without-taking-non-selective-beta-blockers
#6
Grace Lai-Hung Wong, Raymond Kwok, Henry Lik-Yuen Chan, Stephen Pui-Kit Tang, Eugenia Lee, Thomas Chi-Ho Lam, Tiffany Wing-Yan Lau, Teresa Man-Kee Ma, Betsy Chi-Kuen Wong, Vincent Wai-Sun Wong
BACKGROUND & AIMS: The accuracy of liver and spleen stiffness measurement (LSM & SSM) with transient elastography to predict varices in the presence of non-selective beta-blockers (NSBB) has never been studied before. METHODS: This was a cross-sectional study of consecutive patients with chronic hepatitis B (CHB) and cirrhosis. All patients underwent transient elastography and upper endoscopic examinations. Performance of LSM and SSM to predict varices in patients did and did not receive NSBB was evaluated...
May 17, 2016: Journal of Digestive Diseases
https://www.readbyqxmd.com/read/27125068/nonselective-beta-blockers-in-patients-with-cirrhosis-the-therapeutic-window
#7
Mihaela Dimache, Irina Gîrleanu, Eleonora Carpov, Anca Trifan, C Stanciu
For over 30 years, nonselective beta-blockers (NSBB) have been successfully used for preventing variceal bleeding in patients with cirrhosis and portal hypertension. Nevertheless, recent studies suggest that NSBB may be effective only within a particular "therapeutic window" in patients with advanced liver disease. Outside of this window, in early stages of cirrhosis and in very advanced cirrhosis, NSBB may be ineffective and even potentially harmful. In this paper we review the beneficial effects and potential harms of beta-blocker therapy in cirrhosis and underline the most recent recommendations for their use in very advanced cases of liver disease...
January 2016: Revista Medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti Din Iaş̧i
https://www.readbyqxmd.com/read/26829026/nonselective-%C3%AE-blockers-and-survival-in-patients-with-cirrhosis-and-ascites-a-systematic-review-and-meta-analysis
#8
Sakkarin Chirapongsathorn, Nelson Valentin, Fares Alahdab, Chayakrit Krittanawong, Patricia J Erwin, Mohammad H Murad, Patrick S Kamath
BACKGROUND & AIMS: Nonselective β-blockers (NSBBs), given to reduce the risk of variceal bleeding, have been associated with increased mortality in patients with cirrhosis and refractory ascites in some, but not all, studies. We performed a systematic review and meta-analysis to evaluate the effect of NSBBs on all-cause mortality in patients with cirrhosis and refractory ascites. METHODS: We performed a comprehensive search of MEDLINE, Embase, Web of Science, and Scopus databases through January 2015, supplemented with a manual search...
August 2016: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/26827791/assessment-of-response-to-beta-blockers-by-expression-of-%C3%AE-arr2-and-rhoa-rock2-in-antrum-mucosa-in-cirrhotic-patients
#9
Jonel Trebicka, Matthias von Heydebrand, Jennifer Lehmann, Flemming Tofteng, Troels Busk, Helle Lone Jensen, Johan Rohde, Thomas Reiberger, Christian Mortensen, Robert Schierwagen, Sabine Klein, Søren Møller, Flemming Bendtsen, Aleksander Krag
BACKGROUND & AIMS: Non-selective beta-blockers (NSBB) are first choice for prevention of variceal bleeding. But possible deleterious effects in refractory ascites and frequent non-response are clinical drawbacks. Since levels of vasoactive proteins in antrum mucosa reflect vascular dysfunction in cirrhosis, these expression levels might also reflect hemodynamic response to NSBB. METHODS: Biopsies from the gastric and duodenal mucosa of 25 patients with cirrhosis were collected and the hepatic venous pressure gradient (HVPG) was measured before and after an acute propranolol challenge...
June 2016: Journal of Hepatology
https://www.readbyqxmd.com/read/26599983/nonselective-%C3%AE-blockers-do-not-affect-mortality-in-cirrhosis-patients-with-ascites-post-hoc-analysis-of-three-randomized-controlled-trials-with-1198-patients
#10
Lars Bossen, Aleksander Krag, Hendrik Vilstrup, Hugh Watson, Peter Jepsen
UNLABELLED: The safety of nonselective β-blockers (NSBBs) in advanced cirrhosis has been questioned. We used data from three satavaptan trials to examine whether NSBBs increase mortality in cirrhosis patients with ascites. The trials were conducted in 2006-2008 and included 1198 cirrhosis patients with ascites followed for 1 year. We used Cox regression to compare all-cause mortality and cirrhosis-related mortality between patients who did and those who did not use NSBBs at randomization, controlling for age, gender, Model for End-Stage Liver Disease score, Child-Pugh score, serum sodium, previous variceal bleeding, cirrhosis etiology, and ascites severity...
June 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/26519600/treatment-with-non-selective-beta-blockers-is-associated-with-reduced-severity-of-systemic-inflammation-and-improved-survival-of-patients-with-acute-on-chronic-liver-failure
#11
Rajeshwar P Mookerjee, Marco Pavesi, Karen Louise Thomsen, Gautam Mehta, Jane Macnaughtan, Flemming Bendtsen, Minneke Coenraad, Jan Sperl, Pere Gines, Richard Moreau, Vicente Arroyo, Rajiv Jalan
BACKGROUND & AIMS: Non-selective beta blockers (NSBBs) have been shown to have deleterious outcomes in patients with refractory ascites, alcoholic hepatitis and spontaneous bacterial peritonitis leading many physicians to stop the drug in these cases. Acute-on-chronic liver failure (ACLF) is characterized by systemic inflammation and high mortality. As NSBBs may have beneficial effects on gut motility and permeability and, systemic inflammation, the aims of this prospective, observational study were to determine whether ongoing use of NSBBs reduced 28-day mortality in ACLF patients...
March 2016: Journal of Hepatology
https://www.readbyqxmd.com/read/26458850/carvedilol-nsbb-of-choice-in-all-cirrhotics-short-title-carvedilol-for-portal-hypertension
#12
EDITORIAL
Puneeta Tandon, Juan G Abraldes
No abstract text is available yet for this article.
September 2015: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
https://www.readbyqxmd.com/read/26340692/prognosis-of-acute-variceal-bleeding-is-being-on-beta-blockers-an-aggravating-factor-a-short-term-survival-analysis
#13
Andrea Ribeiro de Souza, Vincenzo La Mura, Annalisa Berzigotti, Juan Carlos García-Pagán, Juan G Abraldes, Jaime Bosch
UNLABELLED: Nonselective beta-blockers (NSBB) are widely used because they have been proved effective in the prophylaxis of acute variceal bleeding (AVB). However, a significant proportion of patients still experience AVB while on treatment with NSBB, and its impact on prognosis of AVB is unknown. The present study was aimed at assessing the effect of being on prophylactic therapy with NSBB on 5-day failure and 6-week mortality of patients with cirrhosis admitted with AVB. Included were 142 patients: 49 were receiving prophylactic therapy with NSBB (NSBB group) and 93 were not (control group)...
December 2015: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/25780311/nonselective-beta-blockers-in-cirrhotic-patients-with-no-or-small-varices-a-meta-analysis
#14
REVIEW
Xing-Shun Qi, Yong-Xin Bao, Ming Bai, Wen-Da Xu, Jun-Na Dai, Xiao-Zhong Guo
AIM: To explore effects of nonselective beta-blockers (NSBBs) in cirrhotic patients with no or small varices. METHODS: The PubMed, EMBASE, Science Direct, and Cochrane library databases were searched for relevant papers. A meta-analysis was performed using ORs with 95%CI as the effect sizes. Subgroup analysis was conducted according to the studies including patients without varices and those with small varices. RESULTS: Overall, 784 papers were initially retrieved from the database searches, of which six randomized controlled trials were included in the meta-analysis...
March 14, 2015: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/25611961/the-use-of-beta-blockers-is-associated-with-the-occurrence-of-acute-kidney-injury-in-severe-alcoholic-hepatitis
#15
COMPARATIVE STUDY
Thomas Sersté, Hassane Njimi, Delphine Degré, Pierre Deltenre, Jonas Schreiber, Antonia Lepida, Eric Trépo, Thierry Gustot, Christophe Moreno
BACKGROUND & AIMS: The beneficial effect of nonselective beta-blockers (NSBB) has recently been questioned in patients with end-stage cirrhosis. We analysed the impact of NSBB on outcomes in severe alcoholic hepatitis (AH). METHODS: This study was based on a prospective database of patients with severe, biopsy-proven AH. Patients admitted from July, 2006 to July, 2014 were retrospectively studied. Patients were divided into two groups (with and without NSBB) and assessed for the occurrence of Acute Kidney Injury (AKI) and transplant-free mortality during a 168-day follow-up period...
August 2015: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/25581713/non-selective-beta-blockers-may-reduce-risk-of-hepatocellular-carcinoma-a-meta-analysis-of-randomized-trials
#16
REVIEW
Maja Thiele, Agustín Albillos, Rozeta Abazi, Reiner Wiest, Lise L Gluud, Aleksander Krag
BACKGROUND & AIMS: Non-selective beta-blockers (NSBB) are used in patients with cirrhosis and oesophageal varices. Experimental data suggest that NSBB inhibit angiogenesis and reduce bacterial translocation, which may prevent hepatocellular carcinoma (HCC). We therefore assessed the effect of NSBB on HCC by performing a systematic review with meta-analyses of randomized trials. METHODS: Electronic and manual searches were combined. Authors were contacted for unpublished data...
August 2015: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/25281417/non-selective-%C3%AE-blockers-are-associated-with-improved-survival-in-patients-with-ascites-listed-for-liver-transplantation
#17
Joanna A Leithead, Neil Rajoriya, Nadeem Tehami, James Hodson, Bridget K Gunson, Dhiraj Tripathi, James W Ferguson
OBJECTIVE: Recent data have suggested that non-selective β-blockers (NSBB) are associated with increased mortality in patients with cirrhosis and refractory ascites. However, other evidence implies that NSBB may be beneficial in this setting by reducing bacterial translocation. Our aim was to determine whether NSBB use was a risk factor for mortality in patients with end-stage chronic liver disease and ascites awaiting liver transplantation. DESIGN: This was a single-centre retrospective study of 322 patients with ascites listed January 2007 to July 2011...
July 2015: Gut
https://www.readbyqxmd.com/read/24913395/prevention-of-portal-hypertension-from-variceal-development-to-clinical-decompensation
#18
REVIEW
Julio D Vorobioff, Roberto J Groszmann
Pharmacological treatment of portal hypertension (PH) has been exclusively devoted to gastroesophageal varices-related events at different frameworks, including prophylactic, emergency, or preventive therapy. The goals of treatment are to avoid the first bleeding episode, stop active bleeding, and prevent bleeding recurrence, respectively. The objective of preprimary prophylaxis (PPP) is to avoid variceal development, and therefore it necessarily deals with patients with cirrhosis at earlier stages of the disease...
January 2015: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/24714633/beta-blockers-in-liver-cirrhosis
#19
Valerio Giannelli, Barbara Lattanzi, Ulrich Thalheimer, Manuela Merli
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...
2014: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
https://www.readbyqxmd.com/read/24350068/primary-prevention-of-variceal-bleeding-pharmacological-therapy-versus-endoscopic-banding
#20
REVIEW
Zeid Karadsheh, Harmony Allison
Variceal bleeding is one of the most feared complications in patients with liver cirrhosis. It continues to be a leading cause of death among patients with liver cirrhosis. Although its prognosis has improved over the last several decades, it still carries substantial mortality. Preventing variceal bleeding has been extensively studied and evaluated in several studies in the recent years and the comparison between the different modalities available to prevent variceal bleeding has been an area of discussion...
October 2013: North American Journal of Medical Sciences
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