[The role of beta-blockers in the preventive treatment of rupture of esophageal varices].
beta-blockers, mainly propranolol, have dramatically modified the treatment of portal hypertension. It has been demonstrated that it was possible to decrease portal pressure over a long period and to modify the natural history of gastrointestinal bleeding in cirrhosis. The prevention of first bleeding, or primary prophylaxis, should be distinguished from prevention of rebleeding, or secondary prevention, as these two situations pertain to different events. Concerning primary prophylaxis, at least five randomized controlled trials, (RCT), comparing beta-blockers and placebo, have been published. All the results are homogenous and their meta-analysis suggests that the incidence of first bleeding is significantly decreased but not that of death rate. Results of studies comparing propranolol and sclerotherapy are also available but we know that the results of more than 15 RCT testing sclerotherapy are debated. In secondary prevention, there are more than 10 RCT comparing beta-blockers versus placebo. Results of these RCT are heterogeneous. Meta-analysis suggests that the incidence of rebleeding is significantly decreased but not that of death rate. The results of 5 RCT comparing propranolol versus sclerotherapy are available. Whatever the trial, there was no significant differences between these two treatments. However, meta-analysis suggests that the bleeding incidence is decreased by sclerotherapy but this does not reach statistical significance. Finally, there are RCT with combined treatments: it seems that sclerotherapy plus propranolol is superior to sclerotherapy alone; however this result should be confirmed. In conclusion beta-blockers seem to bring about real changes in the prevention of digestive bleeding in cirrhosis. Their contribution is particularly appreciable in primary prevention of cirrhotic patients with large oesophageal varices.(ABSTRACT TRUNCATED AT 250 WORDS)
Calès
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Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire Purpan, Toulouse, France.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000188:drug therapy*; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012422:Rupture, Spontaneous; D015911:Sclerotherapy
D000319:Adrenergic beta-Antagonists