Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2015; 21(10): 3100-3108
Published online Mar 14, 2015. doi: 10.3748/wjg.v21.i10.3100
Nonselective beta-blockers in cirrhotic patients with no or small varices: A meta-analysis
Xing-Shun Qi, Yong-Xin Bao, Ming Bai, Wen-Da Xu, Jun-Na Dai, Xiao-Zhong Guo
Xing-Shun Qi, Wen-Da Xu, Jun-Na Dai, Xiao-Zhong Guo, Liver cirrhosis group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang 110840, Liaoning Province, China
Yong-Xin Bao, Department of Traditional Medicine, General Hospital of Shenyang Military Area, Shenyang 110840, Liaoning Province, China
Xing-Shun Qi, Ming Bai, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
Author contributions: Qi XS conceived of the study and drafted the manuscript; Qi XS, Bai M, Xu WD and Dai JN performed the literature search and selection, data extraction, quality assessment, and statistical analyses; Guo XZ gave critical comments; Qi XS and Bao YX revised the manuscript; Qi XS, Bao YX and Bai M contributed equally to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xiao-Zhong Guo, MD, PhD, Professor, Liver cirrhosis group, Department of Gastroenterology, General Hospital of Shenyang Military Area, No. 83 Wenhua Road, Shenyang 110840, Liaoning Province, China. guo_xiao_zhong@126.com
Telephone: +86-24-28897603 Fax: +86-24-28851113
Received: August 13, 2014
Peer-review started: August 14, 2014
First decision: September 15, 2014
Revised: September 18, 2014
Accepted: October 14, 2014
Article in press: October 15, 2014
Published online: March 14, 2015
Abstract

AIM: To explore effects of nonselective beta-blockers (NSBBs) in cirrhotic patients with no or small varices.

METHODS: The PubMed, EMBASE, Science Direct, and Cochrane library databases were searched for relevant papers. A meta-analysis was performed using ORs with 95%CI as the effect sizes. Subgroup analysis was conducted according to the studies including patients without varices and those with small varices.

RESULTS: Overall, 784 papers were initially retrieved from the database searches, of which six randomized controlled trials were included in the meta-analysis. The incidences of large varices development (OR = 1.05, 95%CI: 0.25-4.36; P = 0.95), first upper gastrointestinal bleeding (OR = 0.59, 95%CI: 0.24-1.47; P = 0.26), and death (OR = 0.70, 95%CI: 0.45-1.10; P = 0.12) were similar between NSBB and placebo groups. However, the incidence of adverse events was significantly higher in the NSBB group compared with the placebo group (OR = 3.47, 95%CI: 1.45-8.33; P = 0.005). The results of subgroup analyses were similar to those of overall analyses.

CONCLUSION: The results of this meta-analysis indicate that NSBBs should not be recommended for cirrhotic patients with no or small varices.

Keywords: Beta-blocker, Liver cirrhosis, Portal hypertension, Variceal bleeding, Varices

Core tip: Nonselective beta-blockers have been recommended for the primary and secondary prophylaxis of variceal bleeding in cirrhotic patients with high-risk varices and those with previous bleeding. However, their role remains uncertain in cirrhotic patients with no or small varices. Our meta-analysis demonstrates that the use of nonselective beta-blockers should not be recommended for cirrhotic patients with no or small varices.