β‐Blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta‐analysis
Abstract
Introduction: Bacterial infections have been hypothetized to be a trigger of variceal bleeding in cirrhotic patients and β‐blockers may have a protective effect by decreasing bacterial translocation, reducing portal pressure. The aim of our study was to evaluate the possible role of β‐blockers in preventing spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis and ascites. Materials and Methods: Extensive search of the literature including randomized controlled trial (RCT) and non‐RCT of primary and secondary prophylaxis for variceal bleeding in cirrhotics using β‐blockers were evaluated. We performed a meta‐analysis using the occurrence of SBP as endpoint in all the studies, using the random effect model. Results: Three RCT and three retrospective studies in which β‐blockers were evaluated against no treatment for the prevention of SBP in ascitic cirrhotics were included. There was a statistically significant difference of 12.1%, P<0.001 in favour of propranolol in preventing SBP, which was confirmed by sensitivity analysis evaluating only RCTs (7.8% difference). The effect was still present when haemodynamic responders were compared with non‐responders. Conclusions: This analysis suggests a role of β‐blockers in preventing SBP in ascitic cirrhotics, independent of haemodynamic response. Further formal RCTs are needed to confirm this finding.
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Nonselective β-adrenergic blockers decrease intestinal transit time and reduce intestinal bacterial overgrowth, intestinal permeability and bacterial translocation in experimental cirrhosis and patients.
“Accordingly, nonselective β-adrenergic blockers decrease intestinal transit time and reduce intestinal bacterial overgrowth, intestinal permeability and bacterial translocation in experimental models of cirrhosis as well as in patients153–157.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [157]
Cites
de Franchis, R. (2010) · Journal of Hepatology · doi:10.1016/j.jhep.2010.06.004 · Cited by 2,291 · see citing works
de Franchis, R. (2005) · Journal of Hepatology · doi:10.1016/j.jhep.2005.05.009 · Cited by 1,029 · see citing works
Fernández, J., Navasa, M., Planas, R., Montoliu, S., Monfort, D., Soriano, G., Vila, C., Pardo, A., Quintero, E., Vargas, V., et al. (2007) · Gastroenterology · doi:10.1053/j.gastro.2007.06.065 · Cited by 709 · see citing works
Meta‐Analysis in Medical Research
Haidich, A. (2005) · Wiley eBooks · doi:10.1002/9780470994894 · Cited by 691 · see citing works
Abraldeṣ, J. G., Tarantino, I., Turnés, J., García‐Pagán, J. C., Rodés, J., & Bosch, J. (2003) · Hepatology · doi:10.1053/jhep.2003.50133 · Cited by 526 · see citing works
Ruíz-del-Árbol, L., Urmán, J., Fernández, J., González, M., Navasa, M., Monescillo, A., Albillos, A., Jiménez, W., & Arroyo, V. (2003) · Hepatology · doi:10.1053/jhep.2003.50447 · Cited by 493 · see citing works
Prognostic value of early measurements of portal pressure in acute variceal bleeding
Moitinho, E., Escorsell, À., Bandi, J. C., et al. (1999) · Gastroenterology · doi:10.1016/s0016-5085(99)70455-5 · Cited by 489 · see citing works
Hou, M., Lin, H., Liu, T., Kuo, B. I.-T., Lee, F., Chang, F., & Lee, S. (2004) · Hepatology · doi:10.1002/hep.20126 · Cited by 429 · see citing works
Goulis, J., Armonis, A., Patch, D., Sabin, C. A., Greenslade, L., & Burroughs, A. K. (1998) · Hepatology · doi:10.1002/hep.510270504 · Cited by 427 · see citing works
Self-citationInfection, coagulation, and variceal bleeding in cirrhosis
Thalheimer, U., Triantos, C. K., Samonakis, D. N., Patch, D., & Burroughs, A. K. (2005) · Gut · doi:10.1136/gut.2004.048181 · Cited by 317 · see citing works
Self-citationBacterial infection in the pathogenesis of variceal bleeding
Goulis, J., Patch, D., & Burroughs, A. K. (1999) · The Lancet · doi:10.1016/s0140-6736(98)06020-6 · Cited by 286 · see citing works
Self-citationPérez-Paramo, M., Muñoz, J., Albillos, A., Freile, I., Portero, F., Santos, M., & Ortiz-Berrocal, J. (2000) · Hepatology · doi:10.1002/hep.510310109 · Cited by 271 · see citing works
Turnés, J., García‐Pagán, J. C., Abraldeṣ, J. G., Hernández‐Guerra, M., Dell’Era, A., & Bosch, J. (2006) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2006.00453.x · Cited by 225 · see citing works
Bacterial infection in cirrhosis impairs coagulation by a heparin effect: a prospective study
Montalto, P., Vlachogiannakos, J., Cox, D., Pastacaldi, S., Patch, D., & Burroughs, A. K. (2002) · Journal of Hepatology · doi:10.1016/s0168-8278(02)00208-8 · Cited by 200 · see citing works
Self-citationEffect of cisapride on intestinal bacterial overgrowth and bacterial translocation in cirrhosis
Pardo, A., Bartolí, R., Lorenzo-Zúñiga, V., Planas, R., Viñado, B., Riba, J., Cabré, E., Santos, J., Luque, T., Ausina, V., et al. (2000) · Hepatology · doi:10.1053/he.2000.5746 · Cited by 177 · see citing works
How to Prevent Varices From Bleeding: Shades of Grey—The Case for Nonselective β Blockers
Thalheimer, U., Bosch, J., & Burroughs, A. K. (2007) · Gastroenterology · doi:10.1053/j.gastro.2007.10.028 · Cited by 80 · see citing works
Self-citationVioli, F., Basili, S., Ferro, D., et al. (1996) · Thrombosis and Haemostasis · doi:10.1055/s-0038-1650549 · Cited by 65 · see citing works
Hepatic Venous Pressure Gradient and Outcomes in Cirrhosis
Ripoll, C. (2007) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0b013e318150d0f4 · Cited by 50 · see citing works
Cholongitas, Ε., Papatheodoridis, G., Manesis, E. K., Burroughs, A. K., & Archimandritis, A. J. (2005) · Journal of Gastroenterology and Hepatology · doi:10.1111/j.1440-1746.2005.03982.x · Cited by 38 · see citing works
Self-citationTriantos, C. K., Samonakis, D. N., Thalheimer, U., et al. (2004) · Journal of Hepatology · doi:10.1016/j.jhep.2004.07.023 · Cited by 27 · see citing works
Self-citationSersté, T., Bourgeois, N., Lebrec, D., et al. (2007) · PubMed · Cited by 24 · see citing works
Gonzalez-Suarez, B. A., Guarner, C., Villanueva, C., Miñana, J. M., Soriano, G., Gallego, A., Sáinz, S., Torras, X., Cusso, X., & Balanzó, J. (2005) · European Journal of Gastroenterology & Hepatology · doi:10.1097/00042737-200601000-00009 · Cited by 23 · see citing works
Propranolol administration on post surgical infections in cirrhotic patients
Chelarescu, O., Chelarescu, D., Tîrcoveanu, E., & Stratan, I. (2003) · Journal of Hepatology · doi:10.1016/s0168-8278(03)80589-5 · Cited by 18 · see citing works
Endogenous heparinoids contribute to coagulopathy in patients with liver disease
Senzolo, M., Riddell, A. F., Tuddenham, E. G. D., et al. (2007) · Journal of Hepatology · doi:10.1016/j.jhep.2007.11.003 · Cited by 17 · see citing works
Self-citationSenzolo, M., Cholongitas, Ε., Marelli, L., et al. (2006) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2006.00742_5.x · Cited by 16 · see citing works
Self-citationEffect of propranolol for the prevention of spontaneous bacterial peritonitis
Hoshino, S.-I., Shinoura, S., Akamine, H., et al. (2000) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2000.02710.x · Cited by 10 · see citing works
Severi, C., Tattoli, I., Romano, G., et al. (2004) · Canadian Journal of Physiology and Pharmacology · doi:10.1139/y04-042 · Cited by 8 · see citing works
Soylu, A. R., Dökmeci, G., Tezel, A., Amuca, H., & Ümit, H. C. (2003) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2003.07507.x · Cited by 7 · see citing works
[Spontaneous bacterial peritonitis in cirrhotic patients].
Fernándex, M. S., Accatino, L., Croxatto, R. H., et al. (1982) · PubMed · Cited by 5 · see citing works
Antiviral therapy with non-selective β-blockers: preliminary experimental and clinical corroboration
Peuschel, K. E. (2004) · Medical Hypotheses · doi:10.1016/j.mehy.2004.06.030 · Cited by 5 · see citing works
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Guidelines on the management of ascites in cirrhosis
Aithal, G. P., Palaniyappan, N., China, L., Härmälä, S., Macken, L., Ryan, J. M., Wilkes, E. A., Moore, K., Leithead, J. A., Hayes, P. C., et al. (2021) · Gut · doi:10.1136/gutjnl-2020-321790 · Cited by 680 · see citing works
The gut microbiome and liver cancer: mechanisms and clinical translation
Yu, L.-X., & Schwabe, R. F. (2017) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2017.72 · Cited by 634 · see citing works
Mookerjee, R. P., Pavesi, M., Thomsen, K. L., Mehta, G., Macnaughtan, J., Bendtsen, F., Coenraad, M., Sperl, J., Gines, P., Moreau, R., et al. (2016) · Journal of Hepatology · doi:10.1016/j.jhep.2015.10.018 · Cited by 248 · see citing works
Targeting the Gut–Liver Axis in Cirrhosis: Antibiotics and Non-Selective β-Blockers
Madsen, B. S., Havelund, T., & Krag, A. (2013) · Advances in Therapy · doi:10.1007/s12325-013-0044-1 · Cited by 38 · see citing works
Senzolo, M., Fries, W., Buda, A., Pizzuti, D., Nadal, E., Sturniolo, G. C., Burroughs, A. K., & DʼIncà, R. (2009) · American Journal of Gastroenterology · doi:10.1038/ajg.2009.457 · Cited by 36 · see citing works
Self-citation
- Authors
- Senzolo, M., Cholongitas, E., Burra, P., Leandro, G., Thalheimer, U., Patch, D., & Burroughs, A. K.
- Affiliations
- University of Padua (IT)
- Gastroenterology Hospital "Saverio de Bellis" (IT)
- The Royal Free Hospital (GB)
- Corresponding author
- Burroughs, Andrew Kenneth
- ORCID
- Venue
- Liver International
- Publisher
- Wiley
- Published
- 2009-08-03
- Volume
- 29
- Issue
- 8
- Pages
- 1189-1193
- ISSN
- 0106-9543 (ISSN-L)
- 1478-3223
- 1478-3231
- OpenAlex
- W1994589471
- Cited by
- 241
- References
- 30
- Citations by year
- 2026: 1 · 2025: 9 · 2024: 12 · 2023: 14 · 2022: 17 · 2021: 17 · 2020: 17 · 2019: 14 · 2018: 14 · 2017: 15 · 2016: 16 · 2015: 24 · 2014: 20 · 2013: 11 · 2012: 9
- FWCI
- 8.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Liver International (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Keywords
- beta-blockers, spontaneous bacterial peritonitis, liver cirrhosis, ascites, propranolol, variceal bleeding, bacterial translocation, portal hypertension, prophylaxis
- MeSH terms
- Adrenergic beta-Antagonists, Bacterial Infections, Esophageal and Gastric Varices, Gastrointestinal Hemorrhage, Humans, Liver Cirrhosis, Peritonitis, Propranolol, Randomized Controlled Trials as Topic, Databases, Bibliographic, Bacterial Translocation
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