Prevention of decompensation in cirrhosis: a new youth for β blockers

The natural history of cirrhosis can be described as a continuum from a compensated phase to decompensation and liver failure, marked by the development of ascites, overt hepatic encephalopathy, or variceal haemorrhage, occurring at a rate of 5–7% per year. Hepatic venous pressure gradient (HVPG) ha...

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Bibliographic Details
Published in:The Lancet (British edition) 2019-04, Vol.393 (10181), p.1571-1572
Main Authors: Levy, Sharon, Samuel, Didier
Format: Article
Language:English
Subjects:
Antiviral drugs
Ascites
Cirrhosis
Hemorrhage
Hepatic encephalopathy
Hepatitis
Hypertension
Liver
Liver diseases
Patients
Prevention
Subgroups
Timolol
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Summary:The natural history of cirrhosis can be described as a continuum from a compensated phase to decompensation and liver failure, marked by the development of ascites, overt hepatic encephalopathy, or variceal haemorrhage, occurring at a rate of 5–7% per year. Hepatic venous pressure gradient (HVPG) has been shown as the strongest predictor of decompensation with a 90% negative predictive value for HVPG less than 10 mm Hg.2 It has already been shown that non-selective β blockers are effective in reducing portal hypertension and their role in prevention of variceal haemorrhage, once high-risk varices or rupture develop, has been well established.3,4 A trial of timolol5 did not find any difference in the occurrence of varices or variceal haemorrhage between patients with compensated cirrhosis and HVPG greater than 6 mm Hg who were treated with timolol versus placebo. Of note, most of the study patients had active hepatitis C virus infection and follow-up terminated once antiviral treatment was issued.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(19)30736-6