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    Beta-blockers in liver cirrhosis

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    URI
    http://hdl.handle.net/11287/593863
    Author
    Giannelli, V.
    Lattanzi, B.
    Thalheimer, Ulrich
    Merli, M.
    Date
    2014-01-01
    Journal
    Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology
    Type
    Review
    Publisher
    Hellenic Society of Gastroenterology
    Metadata
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    Abstract
    Since the original description of the effectiveness of beta-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 beta-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. For secondary prophylaxis the current recommendation is to receive a combination of NSBB and endoscopic variceal ligation. In addition to lowering portal pressure, NSBB can also reduce bacterial translocation, potentially exerting multiple beneficial effects which go beyond the reduction of bleeding risk. Carvedilol is a NSBB with intrinsic anti-alpha(1)-adrenergic activity, possibly more effective than propranolol in lowering portal hypertension. A potential harmful effect of propranolol in patients with cirrhosis with refractory ascites deserves further confirmation. NSBB remain the cornerstone of therapy in cirrhotic patients with portal hypertension.
    Citation
    Ann Gastroenterol. 2014;27(1):20-26.
    Publisher URL
    http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24714633/
    Note
    This article is available via Open Access. Please click on the 'Additional Link' above to access the full-text.
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