Endoscopic band ligation (EBL) and nonselective β-blockade are two effective strategies in the primary prevention of variceal bleeding. Meta-analyses have shown an advantage of EBL over propranolol with regard to bleeding rates but not mortality. By contrast, a recent randomized, controlled trial shows less bleeding associated with the use of carvedilol compared with EBL.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
McCormick, P. A. & O'Keefe, C. Improving prognosis following a first variceal haemorrhage over four decades. Gut 49, 682–685 (2001).
D'Amico, G., Garcia-Pagan, J. C., Luca, A. & Bosch, J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology 131, 1611–1624 (2006).
Tripathi, D. et al. Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed. Hepatology 50, 825–833 (2009).
Gluud, L. L., Klingenberg, S., Nikolova, D. & Gluud, C. Banding ligation versus beta-blockers as primary prophylaxis in esophageal varices: systematic review of randomized trials. Am. J. Gastroenterol. 102, 2842–2848 (2007).
Banares, R. et al. Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis. Hepatology 36, 1367–1373 (2002).
Bruha, R. et al. Effect of carvedilol on portal hypertension depends on the degree of endothelial activation and inflammatory changes. Scand. J. Gastroenterol. 41, 1454–1463 (2006).
Stanley, A. J., Therapondos, G., Helmy, A. & Hayes, P. C. Acute and chronic haemodynamic and renal effects of carvedilol in patients with cirrhosis. J. Hepatol. 30, 479–484 (1999).
Tripathi, D., Therapondos, G., Lui, H. F., Stanley, A. J. & Hayes, P. C. Haemodynamic effects of acute and chronic administration of low-dose carvedilol, a vasodilating beta-blocker, in patients with cirrhosis and portal hypertension. Aliment. Pharmacol. Ther. 16, 373–380 (2002).
Senzolo, M. et al. Beta-blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis. Liver Int. 29, 1189–1193 (2009).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Tsochatzis, E., Triantos, C. & Burroughs, A. Carvedilol—the best β-blocker for primary prophylaxis?. Nat Rev Gastroenterol Hepatol 6, 692–694 (2009). https://doi.org/10.1038/nrgastro.2009.198
Issue Date:
DOI: https://doi.org/10.1038/nrgastro.2009.198
This article is cited by
-
Management of varices in patients with cirrhosis
Nature Reviews Gastroenterology & Hepatology (2013)
-
Primary Prevention of Variceal Hemorrhage
Current Gastroenterology Reports (2011)