The prognostic value of HVPG-response to non-selective beta-blockers in patients with NASH cirrhosis and varices

Paternostro, Rafael; Becker, Jeannette; Hofer, Benedikt; Panagl, Vera; Schiffke, Helena; Simbrunner, Benedikt; Semmler, Georg; Schwabl, Philipp; Scheiner, Bernhard; Bucsics, Theresa; Bauer, Dávid; Binter, Teresa; Trauner, Michael; Mandorfer, Mattias; Reiberger, Thomas

doi:10.1016/j.dld.2021.09.009

Cited by 18 publications

(22 citation statements)

References 48 publications

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“…39 In NASH cirrhosis, a decrease in HVPG after nonselective beta blocker was not predictor of decompensation or long-term transplant free survival. 40 Therefore, routine HVPG measurement may not be an ideal tool for detection and monitoring of portal hypertension in NAFLD or different HVPG cutoff level should be established for NAFLD. Some noninvasive tools have been developed for the detection of CSPH through measurement of liver or spleen tissue stiffness.…”

Section: Diagnosismentioning

confidence: 99%

Portal Hypertension in Nonalcoholic Fatty Liver Disease: From Pathogenesis to Clinical Practice

Nababan¹,

Lesmana²

2022

J Clin Transl Hepatol

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Portal hypertension in nonalcoholic fatty liver disease (NAFLD) mostly occur in cirrhotic stage. However, several experimental and clinical studies showed evidence of portal hypertension in NAFLD without significant or advance fibrosis. This early development of portal hypertension in NAFLD is associated with liver sinusoidal contraction by hepatocellular lipid accumulation and ballooning, which is also accompanied by capillarization and dysfunction of liver sinusoidal endothelial cells. Both of these impaired mechanical and molecular components can cause an increase in intrahepatic vascular resistance which lead to the increase of portal pressure in the absence of significant liver fibrosis. Extrahepatic factors such as insulin resistance and gut dysbiosis may also contribute to liver sinusoidal endothelial dysfunction and early portal hypertension in NAFLD. The clinical impact of early portal hypertension in NAFLD is still unclear. However, clinical tools for diagnosis and monitoring of portal hypertension in NAFLD are being investigated to predict high-risk patients and to guide therapy.

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Section: Diagnosismentioning

confidence: 99%

Portal Hypertension in Nonalcoholic Fatty Liver Disease: From Pathogenesis to Clinical Practice

Nababan¹,

Lesmana²

2022

J Clin Transl Hepatol

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“…The mechanism through which beta blockers are considered to be active is through the reduction of portal pressure. There is no compelling evidence of differences in treatment response by disease aetiology, 38 though recent nonrandomized data in a small sample of patients may suggest perhaps a lower hemodynamic response rate in patients with NASH cirrhosis 39 . Overall however, we expect that similar relative effect sizes will be seen in all patient groups.…”

Section: Discussionmentioning

confidence: 83%

Quantifying the benefit of nonselective beta-blockers in the prevention of hepatic decompensation: A Bayesian reanalysis of the PREDESCI trial

Rowe¹,

Villanueva²,

Shearer³

et al. 2023

Hepatology

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Background and Aims: Beta-blockers have been studied for the prevention of variceal bleeding and, more recently, for the prevention of all-cause decompensation. Some uncertainties regarding the benefit of beta-blockers for the prevention of decompensation remain. Bayesian analyses enhance the interpretation of trials. The purpose of this study was to provide clinically meaningful estimates of both the probability and magnitude of the benefit of beta-blocker treatment across a range of patient types.

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“…Так, из 452 пациентов с асцитом ответ на прием НСББ (снижение ГПВД более чем на 20% от исходного уровня) был получен только у 188 больных ЦП (42%), что обусловливало более низкие шансы на развитие кровотечений из ВУ, рефрактерного асцита, спонтанного бактериального перитонита или гепаторенального синдрома [17]. В другом исследовании Paternostro et al [18] сообщили, что ГПВД -ответ на прием НСББ в течение 90 дней -был получен у 55,3% с ЦП и наличием ВУ. Авторы подчеркнули, что абсолютно все случаи развития кровотечений из ВУ были у ГПВД-НСББ -nonresponders (нон-респондеров, или не-ответчиков).…”

Section: Discussionunclassified

Nonselective beta-blockers in primary prophylaxis of esophageal variceal bleeding in patients with ascites waitlisted for liver transplantation

Коробка

Пасечников²,

Korobka

et al. 2023

RJTAO

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Objective: to determine the efficacy of non-selective beta-blockers (NSBBs) in the primary prevention of bleeding esophageal varices and to assess their impact on the survival of patients with ascites enrolled in the liver transplant waiting list (LTWL).Materials and methods. We carried out a retrospective comparative study of cirrhotic patients with severe ascites and esophageal varices without bleeding before enrollment in the LTWL. Primary prophylaxis of variceal bleeding included the use of NSBBs (n = 97, group 1). These drugs were not used in the other patients (n = 91, group 2).Results. There were no significant differences between the groups in terms of clinical, laboratory and demographic parameters, MELD scores and Child-Turcotte-Pugh (CTP) classes for cirrhosis. Patient groups included in the study had no significant differences with respect to incidence of medium- and large-sized varices and incidence of severe ascites. Bleeding incidence was significantly lower in the NSBBs group than in the non-NSBBs group (52.6% and 95.6%, respectively, p = 0.0001).Conclusion. NSBBs constitute an efficacious therapy in primary prophylaxis of esophageal variceal bleeding, thereby saving life and preventing delisting of patients with ascites from the LTWL.

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The prognostic value of HVPG-response to non-selective beta-blockers in patients with NASH cirrhosis and varices

Cited by 18 publications

References 48 publications

Portal Hypertension in Nonalcoholic Fatty Liver Disease: From Pathogenesis to Clinical Practice

Portal Hypertension in Nonalcoholic Fatty Liver Disease: From Pathogenesis to Clinical Practice

Quantifying the benefit of nonselective beta-blockers in the prevention of hepatic decompensation: A Bayesian reanalysis of the PREDESCI trial

Nonselective beta-blockers in primary prophylaxis of esophageal variceal bleeding in patients with ascites waitlisted for liver transplantation

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