INTRODUCTION: Bacterial infections have been hypothetized to be a trigger of variceal bleeding in cirrhotic patients and beta-blockers may have a protective effect by decreasing bacterial translocation, reducing portal pressure. The aim of our study was to evaluate the possible role of beta-blockers in preventing spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis and ascites. MATERIALS AND METHODS: Extensive search of the literature including randomized controlled trial (RCT) and non-RCT of primary and secondary prophylaxis for variceal bleeding in cirrhotics using beta-blockers were evaluated. We performed a meta-analysis using the occurrence of SBP as endpoint in all the studies, using the random effect model. RESULTS: Three RCT and three retrospective studies in which beta-blockers were evaluated against no treatment for the prevention of SBP in ascitic cirrhotics were included. There was a statistically significant difference of 12.1%, P<0.001 in favour of propranolol in preventing SBP, which was confirmed by sensitivity analysis evaluating only RCTs (7.8% difference). The effect was still present when haemodynamic responders were compared with non-responders. CONCLUSIONS: This analysis suggests a role of beta-blockers in preventing SBP in ascitic cirrhotics, independent of haemodynamic response. Further formal RCTs are needed to confirm this finding.
INTRODUCTION: Bacterial infections have been hypothetized to be a trigger of variceal bleeding in cirrhotic patients and beta-blockers may have a protective effect by decreasing bacterial translocation, reducing portal pressure. The aim of our study was to evaluate the possible role of beta-blockers in preventing spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis and ascites. MATERIALS AND METHODS: Extensive search of the literature including randomized controlled trial (RCT) and non-RCT of primary and secondary prophylaxis for variceal bleeding in cirrhotics using beta-blockers were evaluated. We performed a meta-analysis using the occurrence of SBP as endpoint in all the studies, using the random effect model. RESULTS: Three RCT and three retrospective studies in which beta-blockers were evaluated against no treatment for the prevention of SBP in ascitic cirrhotics were included. There was a statistically significant difference of 12.1%, P<0.001 in favour of propranolol in preventing SBP, which was confirmed by sensitivity analysis evaluating only RCTs (7.8% difference). The effect was still present when haemodynamic responders were compared with non-responders. CONCLUSIONS: This analysis suggests a role of beta-blockers in preventing SBP in ascitic cirrhotics, independent of haemodynamic response. Further formal RCTs are needed to confirm this finding.
Authors: Georgios I Tsiaoussis; Stelios F Assimakopoulos; Athanassios C Tsamandas; Christos K Triantos; Konstantinos C Thomopoulos Journal: World J Hepatol Date: 2015-08-18
Authors: Damian J Harding; M Thamara P R Perera; Frederick Chen; Simon Olliff; Dhiraj Tripathi Journal: World J Gastroenterol Date: 2015-06-14 Impact factor: 5.742