The American Journal of Medicine
Volume 116, Issue 11 , Pages 759-766, 1 June 2004

An Evidence-Based medicine approach to Beta-blocker therapy in patients with cirrhosis

  • Jayant A Talwalkar, MD, MPH

      Affiliations

    • Advanced Liver Diseases Study Group, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    • Corresponding Author InformationRequests for reprints should be addressed to Jayant A. Talwalkar, MD, MPH, Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, Minnesota 55905, USA
  • ,
  • Patrick S Kamath, MD

      Affiliations

    • Advanced Liver Diseases Study Group, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

Received 12 February 2003; accepted 3 March 2004.

Abstract 

Disease management strategies have gained attention in recent years because of their potential to improve health-related quality of life and prevent excessive resource use. Despite recognition as an important cause of mortality, cirrhosis with portal hypertension has not been widely discussed as a condition amenable to planned care management. Given the effect of variceal hemorrhage as the most immediate life-threatening complication of portal hypertension, a number of high-quality controlled clinical trials have confirmed the efficacy of beta-blocker therapy for primary and secondary prophylaxis. Despite the existence of practice guidelines that incorporate this information, specific clinical scenarios that demand consideration for beta-blocker therapy have not been well described. In this article, a number of hypothetical patient-based cases drawn from the authors' experiences are utilized to illustrate these issues.

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PII: S0002-9343(04)00210-4

doi:10.1016/j.amjmed.2004.03.006

The American Journal of Medicine
Volume 116, Issue 11 , Pages 759-766, 1 June 2004