RESUMEN
BACKGROUND: The established use of non-selective beta-blockers (NSBB) in the primary and secondary prevention of esophageal varices has recently been questioned in the subgroup of patients with diuretic-refractory ascites. OBJECTIVE: Critically analyze the body of evidence on the topic in order to assist clinical decisions. METHODS: A literature review was carried out in the Pubmed® and Scielo® databases. In total, 20 articles between 2010 and 2023 were read by independent researchers. CONCLUSION: It remains doubtful whether the use of NSBB is deleterious in cirrhotic patients with refractory ascites, however our literature review allows us to conclude that these drugs should not be proscribed in these patients. On the contrary, a doctor-patient decision based on tolerability and hemodynamic parameters certainly seems to be a safe conduct.
Asunto(s)
Antagonistas Adrenérgicos beta , Ascitis , Várices Esofágicas y Gástricas , Cirrosis Hepática , Humanos , Ascitis/tratamiento farmacológico , Ascitis/etiología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/tratamiento farmacológico , Antagonistas Adrenérgicos beta/uso terapéutico , Várices Esofágicas y Gástricas/tratamiento farmacológico , Várices Esofágicas y Gástricas/complicacionesRESUMEN
ABSTRACT Background: The established use of non-selective beta-blockers (NSBB) in the primary and secondary prevention of esophageal varices has recently been questioned in the subgroup of patients with diuretic-refractory ascites. Objective: Critically analyze the body of evidence on the topic in order to assist clinical decisions. Methods: A literature review was carried out in the Pubmed® and Scielo® databases. In total, 20 articles between 2010 and 2023 were read by independent researchers. Conclusion: It remains doubtful whether the use of NSBB is deleterious in cirrhotic patients with refractory ascites, however our literature review allows us to conclude that these drugs should not be proscribed in these patients. On the contrary, a doctor-patient decision based on tolerability and hemodynamic parameters certainly seems to be a safe conduct.
RESUMO Contexto: O uso consagrado de betabloqueadores não seletivos (BBNS) na prevenção primária e secundária de varizes esofágicas foi recentemente questionado no subgrupo de pacientes com ascite refratária a diurético. Objetivo: Analisar criticamente o corpo de evidências sobre a temática a fim de auxiliar decisões clínicas. Métodos: Foi realizada uma revisão da literatura nos bancos de dados Pubmed® e Scielo®. No total, 20 artigos entre os anos 2010 e 2023 foram lidos por pesquisadores independentes. Conclusão: Ainda permanece duvidoso se o uso de BBNS é deletério nos cirróticos com ascite refratária, no entanto nossa revisão de literatura permite concluir que essas drogas não devem ser proscritas nesses pacientes. Ao contrário, uma decisão médico-paciente pautada na tolerabilidade e em parâmetros hemodinâmicos parece ser uma conduta decerto segura.