Beta-blockers are extensively used to prevent variceal bleeding in patients with large esophageal varices.
However, it is not clear whether beta-blockers delay the growth of small varices.
In this study, doctors from Italy evaluated 161 patients with cirrhosis and small esophageal varices without previous bleeding.
The team randomized 83 patients to receive nadolol (dose adjusted to decrease resting heart rate by 25%, mean dose = 62 mg/day). The remaining 78 patients received placebo.
The principal end point was occurrence of large esophageal varices.
The team performed an endoscopic examination at 12, 24, 36, 48, and 60 months of follow-up. Mean follow-up was 36 months.
|The cumulative probability of variceal bleeding was lower in the nadolol patients.|
The doctors found that during the study period, 9 nadolol patients and 29 placebo patients had growth of esophageal varices.
The team calculated the cumulative risk at the end of follow-up: 20% versus 51%.
When possible confounding factors were taken into account, the team found that treatment was a significant factor predicting growth of varices (odds ratio, 4.0).
They determined that the cumulative probability of variceal bleeding was lower in patients randomized to nadolol.
Survival was not different between the groups, however adverse effects from withdrawal of the drug occurred in 9 patients in the nadolol group and 1 patient in the placebo group.
Dr Carlo Merke and colleagues concluded, "This study suggests that beta-blocker prophylaxis of variceal bleeding in patients with compensated cirrhosis should be started when small esophageal varices are present".