Tips from Other Journals

Do Beta Blockers Prevent Varices in Cirrhosis?



FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.


FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Am Fam Physician. 2006 Jun 15;73(12):2223-2224.

Nonselective beta blockers are standard therapy in lowering portal venous pressure to prevent variceal bleeding in patients with cirrhosis and esophageal varices. However, it is not known if the same treatment will prevent varices from forming. Groszmann and colleagues conducted a randomized, double-blind, placebo-controlled trial of timolol (Betimol) in patients with cirrhosis and portal hypertension.

They authors enrolled 213 patients with cirrhosis and elevated portal pressures, which are defined by a hepatic venous pressure gradient of 6 mm Hg or greater. Most patients were white men. The absence of varices was proven endoscopically. In the study, there was an initial dose titration phase during which all patients received timolol, followed by a trial phase in which the patients were randomized to timolol or placebo. Patients were analyzed every three months through physical examination and laboratory assessment and underwent annual endoscopy and measurement of hepatic venous pressure gradient. Median follow-up duration was 55 months. The primary end point was the development of esophageal varices or variceal bleeding. Secondary end points included ascites, encephalopathy, liver transplant, or death.

There was no significant difference in the number of patients reaching the primary end point (42 in the timolol group [39 percent] and 42 in the placebo group [40 percent]). The two groups also were equal in reaching the secondary end points. Adverse events were more common in the group treated with timolol. The authors conclude that these findings do not support the use of nonselective beta blockers for preventing esophageal variceal formation in patients with cirrhosis and portal hypertension.

Groszmann RJ, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med. November 24, 2005;353:2254–61.



Copyright © 2006 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

Navigate this Article