MEDICAL-TREATMENT OF PORTAL-HYPERTENSION

Several agents can reduce portal pressure in patients with portal hypertension. These drugs act in different ways and have different actions. Several hemodynamic investigations have elucidated the effects of beta-blockade on the splanchnic circulation. Propranolol and other non-selective beta-blockers significantly decreased portal pressure in patients with cirrhosis. In some patients, beta-blockers did not decrease portal pressure while cardiac output and azygos blood flow significantly decreased. The cause and severity of cirrhosis do not influence the effect of beta-blockers. The efficacy of beta-blockers in the prevention of the first gastrointestinal bleeding is well established. Meta-analysis showed that among patients receiving beta-blockers, 10 per cent bled 1 year after inclusion as against 30 per cent in the placebo group. A significant difference in survival rate was also observed between the two groups. The efficacy of beta-blockers in the prevention of recurrent gastrointestinal bleeding is variable; 5 trials showed a significant difference while 3 did not show any significant difference between patients receiving beta-blockers and those receiving a placebo. Meta analysis showed a significant difference in the risk of rebleeding but did not show any difference in survival rate. Thus, beta-blockers reduce the degree of portal hypertension in patients with cirrhosis and decrease the risk of gastrointestinal bleeding in compliant patients.