An evidence-based medicine approach to beta-blocker therapy in patients with cirrhosis.
Disease management strategies have gained attention in recent years because of their potential to improve health-related quality of life and prevent excessive resource use. Despite recognition as an important cause of mortality, cirrhosis with portal hypertension has not been widely discussed as a condition amenable to planned care management. Given the effect of variceal hemorrhage as the most immediate life-threatening complication of portal hypertension, a number of high-quality controlled clinical trials have confirmed the efficacy of beta-blocker therapy for primary and secondary prophylaxis. Despite the existence of practice guidelines that incorporate this information, specific clinical scenarios that demand consideration for beta-blocker therapy have not been well described. In this article, a number of hypothetical patient-based cases drawn from the authors' experiences are utilized to illustrate these issues.
Talwalkar
Jayant A
JA
Advanced Liver Diseases Study Group, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. talwalkar.jayant@mayo.edu
Kamath
Patrick S
PS
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection
D000319:Adrenergic beta-Antagonists