[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 effects 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.