Prevention of upper gastrointestinal bleeding from portal hypertension in cirrhosis: rationale for medical treatment.
We updated meta-analysis and critical descriptive analysis of randomized clinical trials (RCTs) assessing the value of beta-blockers in preventing first bleeding (prophylactic) or rebleeding (therapeutic) and on survival of patients with cirrhosis. Both the methods of Peto-Mantel-Haenszel and DerSimonian-Laird were used to assess the heterogeneity and obtain cumulative estimates of treatment effects; the L'Abbé plot was also used for a visual assessment of heterogeneity in the direction of treatment effect. Seven prophylactic and nine therapeutic RCTs were analysed. beta-Blockers uniformly reduced the bleeding risk and revealed a trend toward improved survival in non-ascitic, well-compensated patients in both the prophylactic and therapeutic sets of RCTs. Discordant results were found in patients with ascites or in poor functional condition.
Clinica Medica R, Università di Palermo, Italy.
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Pagliaro
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D'Amico
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Tinè
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Pasta
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D004932:Esophageal and Gastric Varices / Q000517:prevention & control*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006439:Hemodynamics; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000188:drug therapy*; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications*; D012008:Recurrence
D000319:Adrenergic beta-Antagonists