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Published in Gastroenterology

Expert Opinion / My Approach · October 22, 2014

MY APPROACH to the Use of Non-Selective Beta Blockers in Patients With Cirrhosis and Ascites

Written by
Juan Carlos Garcia-Pagán MD, PhD
Virginia Hernández-Gea MD


Additional Info

  1. Villanueva C, Lopez-Balaguer JM, Aracil C, et al. Maintenance of hemodynamic response to treatment for portal hypertension and influence on complications of cirrhosis. J Hepatol. 2004;40(5):757-765.
  2. Abraldes JG, Tarantino I, Turnes J, et al. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology. 2003;37(4):902-908.
  3. Hernandez-Gea V, Aracil C, Colomo A, et al. Development of ascites in compensated cirrhosis with severe portal hypertension treated with beta-blockers. Am J Gastroenterol. 2012;107(3):418-427.
  4. Reiberger T, Ferlitsch A, Payer BA, et al. Non-selective betablocker therapy decreases intestinal permeability and serum levels of LBP and IL-6 in patients with cirrhosis. J Hepatol. 2013;58(5):911-921.
  5. Senzolo M, Cholongitas E, Burra P, et al. Beta-blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis. Liver Int. 2009;29(8):1189-1193.
  6. Ferrarese A, Germani G, Rodriguez-Castro KI, et al. Bleeding-unrelated mortality is not increased in patients with cirrhosis and ascites on treatment with β-blockers: A meta-analysis. Dig Liver Dis. 2014;46(Suppl 1):e31.
  7. Serste T, Melot C, Francoz C, et al. Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology 2010;52(3):1017-1022.
  8. Garcia-Pagan JC. Portal hypertension: Nonselective beta-blockers in patients with refractory ascites. Nat Rev Gastroenterol Hepatol. 2011;8(1):10-11.
  9. Serste T, Francoz C, Durand F, et al. Beta-blockers cause paracentesis-induced circulatory dysfunction in patients with cirrhosis and refractory ascites: a cross-over study. J Hepatol. 2011;55(4):794-799.
  10. Mandorfer M, Bota S, Schwabl P, et al. Nonselective beta blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. Gastroenterology. 2014;146(7):1680-1690.
  11. Krag A, Wiest R, Albillos A, Gluud LL. The window hypothesis: haemodynamic and non-haemodynamic effects of beta-blockers improve survival of patients with cirrhosis during a window in the disease. Gut. 2012;61(7):967-969.

Further Reading