Ascites and Cirrhosis
Accumulation of fluid in the abdominal cavity is called ascites. Ascites is common in people with cirrhosis
10/03/2017
13/06/2016
Randomized, controlled trial data indicate that beta-blockers can be safely used in patients with cirrhosis, including those with refractory ascites.
An About-Face on Beta-Blocker Use in Decompensated Cirrhosis
Atif Zaman, MD, MPH reviewing Bossen L et al. Hepatology 2016 Jun.
Randomized, controlled trial data indicate that beta-blockers can be safely used in patients with cirrhosis, including those with refractory ascites.
Beta-blocker use in patients with severe decompensated cirrhosis may increase mortality (NEJM JW Gastroenterol Aug 2014 and Gastroenterology 2014; 146:1680).
To investigate this issue further, researchers conducted a post hoc analysis of risk for all-cause mortality and cirrhosis-related mortality using individual patient data from three industry-funded randomized, controlled trials of the efficacy and safety of satavaptan in treating ascites. Of 1188 participants, 588 had refractory ascites and the rest had diuretic-responsive ascites.
Rates of 52-week all-cause mortality and cirrhosis-related mortality were similar between the 559 beta-blocker users and 629 nonusers (hazard ratios, 0.92 and 1.00, respectively). All-cause mortality was also similar between beta-blocker users and nonusers in the subgroup of patients with refractory ascites. Cessation of therapy among initial beta-blocker users occurred in 29% and was associated with a significant increase in mortality risk (HR, 5.13).
COMMENT
Although these findings are based on a post hoc analysis, study strengths included prospective collection of individual patient–level data, and a sufficiently large sample size to allow for adjustment of multiple potential confounders. However, some details that would normally be available in a randomized control trial, such as the specific reason for drug discontinuation that led to a higher mortality, were not available. Until a more definitive randomized, controlled trial is performed, these findings indicate that for now beta-blocker therapy should be considered safe in cirrhosis and should be used when indicated. It can also be safely used in refractory ascites, but with caution (possibly at lower doses) when there is concern for hypotension or acute kidney injury. An about-face has occurred.
An About-Face on Beta-Blocker Use in Decompensated Cirrhosis Dr. Atif Zaman tells us what the findings mean for patient care.
10/06/2016
Renin Angiotensin Aldosterone System
Renin Angiotensin Aldosterone System Watch 700+ videos at http://www.DrNajeebLectures.com
10/05/2016
Best of Cirrhosis and Complications debrief at ILC 2016
Best of Cirrhosis and Complications debrief at ILC2016 Watch Pr. Rajiv Jalan and Pr. Paolo Angeli discuss the best of cirrhosis and complications at ILC2016. A detailed review of the latest in patient management ...
GI All-In-One GI All-In-One
Ascites and Cirrhosis Accumulation of fluid in the abdominal cavity is called ascites. Ascites is common in people with ci
Hepatitis C Virus - HCV Hepatitis C is an infectious disease affecting primarily the liver, caused by the hepatitis C virus
Non-Alcoholic Fatty Liver Disease NAFLD NAFLD is one cause of a fatty liver, occurring when fat is deposited (steatosis) in the liver not du
Hepato Cellular Carcinoma - HCC HCC is the most common type of liver cancer. Most cases of HCC are secondary to either a viral hepat
Primary Biliary Cirrhosis - PBC Primary biliary cirrhosis (PBC) is a progressive disease of the liver caused by a buildup of bile wi
19/12/2015
Renin Angiotensin Aldosterone System Renin Angiotensin Aldosterone System...
23/09/2015
كل عام وانتم بخير
الان - في امكانكم سؤالي في امراض الجهاز الهضمي والكبد على السناب شات من كل من المختصين في المجال الطبي او المرضى والحصول على الجواب بطريقه تفاعليه وشبه مباشره - استفيد من الفرصه - د وليد خالد محروس استشاري امراض الجهاز الهضمي والكبد ومناظير القنوات المراريه والمناظير العلاجيه والتشخيصيه المتقدمه في السعوديه - الرياض
NOW - Start to ask any advanced professional gastroenterology and hepatology questions that for physician or patient related and get the answer interactively and near directly by your snape chat , try it now and not miss the benefit .
12/06/2015
Can we Promote Liver Regeneration in Patients with Decompensated Cirrhosis?
Can we Promote Liver Regeneration in Patients with Decompensated Cirrhosis? The combination of granulocyte colony-stimulating factor (G-CSF) and a long-acting form of erythropoietin increases survival of patients with decompensated cirrhosis, researchers report in the June...
10/06/2015
Gastroenterology Hepatology Endoscopy Provide up-to-date information on a number of topics in which there is rapidly accumulating informat