Letters to the editor

Non-selective β-adrenoceptor blockers in patients with decompensated liver disease

Editor – We read with great interest the excellent article ‘Drug therapies in liver disease’ by Collins et al (Clin Med December 2013 pp 585–91). However, the section regarding the use of β-blockers warrants further comment.

Although the use of non-selective β-adrenoceptor blockers is strongly supported in the use of primary and secondary prophylaxis of variceal bleeding,¹ there has been some controversy with its use in patients with advanced cirrhosis. In a study by Serste et al,² 151 patients with Child Pugh C cirrhosis and refractory ascites were assessed. Seventy-seven patients were being treated with β-blockers and 74 were not. At 1 year, 19% of patients treated with β-blockers were alive, compared to 64% who were not (p < 0.0001). A follow-up study by the same group found that inpatients with refractory ascites and on β-blockers had a higher risk of paracentesis-induced circulatory dysfunction.

Admittedly the studies have flaws and robust randomised controlled trials are needed, but clinicians should be cautious when using these drugs in patients with advanced liver disease.