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Beta-blockers reduced bacterial translocation, improved intestinal permeability in cirrhotic patients

Patients with cirrhosis treated with beta-blockers experienced improved intestinal permeability and reduced bacterial translocation, reducing the risk for variceal bleeding, in a study presented at The International Liver Congress in Amsterdam.

In a study of 50 patients with cirrhosis, participants’ portal pressure, gastroduodenal and intestinal permeability and LPS-binding protein (LBP) and interleukin-6 (IL-6) levels were measured before and after treatment with nonselective beta-blockers (NSBB). Rates of bleeding and mortality were determined during follow-up.

Severe portal hypertension, defined as hepatic venous pressure gradient (HPVG) of 20 mmHg or greater, was observed in 35 cases. These patients had significantly higher urine sucrose levels (P=.049), sucrose/mannitol ratios (P=.007) and intestinal permeability indices (P=.002), as well as increased LBP (P=.002) and IL-6 levels (P=.025) compared with those with an HPVG less than 20 mmHg. Patients treated with NSBB experienced significant reductions to HVPG, LBP (–16%; P=.018) and IL-6 (–41%; P<.0001).

Those with abnormal gastroduodenal or intestinal permeability, as indicated by sucrose-lactulose-mannitol test results, trended toward increased incidence of variceal bleeding (P=.066 for gastroduodenal and P=.084 for intestinal permeability), as did those with elevated LBP (P=.18) and/or IL-6 (P=.038). Despite the increased incidence rate, none of these conditions was associated with increased mortality (P=.87 for gastroduodenal and P=.994 for intestinal permeability, P=.571 for elevated LBP and P=.594 for elevated IL-6).

“Beta-blockers have been successfully used … as a standard treatment to control blood pressure in other disease areas,” Mauro Bernardi, MD, treasurer of the EASL, said in a press release. “In cirrhosis, they have been used for decades for primary and secondary prophylaxis of bleeding from esophageal varices. The results of this study show that besides improving portal hypertension … their beneficial effects are also due to their ability to reduce bacterial translocation, which may widen the indication for the use of these drugs in this setting.”

For more information:

Reiberger T. #84: Improvement of Intestinal Permeability and Reducing Bacterial Translocation by Betablocker Treatment is Associated with a Lower Risk of Variceal Bleeding. Presented at: the International Liver Congress 2013; April 24-28, Amsterdam.