Gastroenterology 2014;147:941–942
CORRESPONDENCE Readers may submit letters to the editor concerning articles that appeared in Gastroenterology within one month of publication. Detailed guidelines regarding the content are included in the Instructions to Authors.
b Blockers in Liver Cirrhosis Dear Editor: We read with interest the recent retrospective study on the role of nonselective b-blockers (NSBBs) in patients with cirrhosis and spontaneous bacterial peritonitis (SBP) by Mandorfer et al.1 The authors performed analysis of data from 607 consecutive patients with cirrhosis who underwent an abdominal paracentesis and investigated the effect of NSBBs on transplant-free survival. They reached a strong conclusion that patients with cirrhosis and SBP should not receive NSBBs. Although it is a retrospective study it is well conducted and the authors have performed indeed a very careful statistical analysis in a large cohort of patients. However, we take issue as we feel that retrospective data should be interpreted with caution in this field as might lead to a reduction in the use of these highly effective and very cheap agents with deleterious effect in the every-day clinical practice in the management of patients with liver cirrhosis. Cirrhotic patients with lower blood pressure have shorter survival. Development of SBP has been shown to be associated with systemic hemodynamic derangements. In addition, a well known contraindication of NSBBs is reduced mean arterial pressure (MAP). The proportion of patients with systolic arterial pressure (SAP)
CORRESPONDENCE Readers may submit letters to the editor concerning articles that appeared in Gastroenterology within one month of publication. Detailed guidelines regarding the content are included in the Instructions to Authors.
b Blockers in Liver Cirrhosis Dear Editor: We read with interest the recent retrospective study on the role of nonselective b-blockers (NSBBs) in patients with cirrhosis and spontaneous bacterial peritonitis (SBP) by Mandorfer et al.1 The authors performed analysis of data from 607 consecutive patients with cirrhosis who underwent an abdominal paracentesis and investigated the effect of NSBBs on transplant-free survival. They reached a strong conclusion that patients with cirrhosis and SBP should not receive NSBBs. Although it is a retrospective study it is well conducted and the authors have performed indeed a very careful statistical analysis in a large cohort of patients. However, we take issue as we feel that retrospective data should be interpreted with caution in this field as might lead to a reduction in the use of these highly effective and very cheap agents with deleterious effect in the every-day clinical practice in the management of patients with liver cirrhosis. Cirrhotic patients with lower blood pressure have shorter survival. Development of SBP has been shown to be associated with systemic hemodynamic derangements. In addition, a well known contraindication of NSBBs is reduced mean arterial pressure (MAP). The proportion of patients with systolic arterial pressure (SAP)
