Review
Copyright ©The Author(s) 2016.
World J Pharmacol. Mar 9, 2016; 5(1): 15-31
Published online Mar 9, 2016. doi: 10.5497/wjp.v5.i1.15
Figure 2
Figure 2 Extended - “window hypothesis” adapted and revised from Krag et al[21]. The window hypothesis illustrates that in early portal hypertension when low risk of bacterial translocation and adequate cardiac compensatory reserve, NSBBs have no effect on survival[25,67]. As disease progresses and varices enlarge there is clear benefit of NSBB in primary and secondary prophylaxis in improving mortality and also reducing rebleeding rates. The original widow hypothesis[21] commented that the window for benefit of NSBBs then may indeed close in decompensated cirrhosis (e.g., patients with refractory ascites[20]) however the data from Leithead et al[22] would suggest the window may indeed remain open even in such patients for a period of time. This window however may indeed close once patients have developed an episode of SBP[90]. SNS: Sympathetic nervous system activity; NSBB: Non-selective beta-blocker; SBP: Spontaneous bacterial peritonitis.