Non-selective beta blockers prevent variceal bleeding.
Varices are abnormally distended veins found in the esophagus, intestines and stomach and are a common complication of cirrhosis of the liver. If left alone, they can cause massive internal bleeding which can be life threatening .Beta blockers are a group of drugs mainly used to treat conditions related to the heart such as high blood pressure. Non-selective beta blockers have been shown to prevent varices from bleeding, but can not stop them from forming and as such are recommended to prevent variceal bleeds from occurring once they have been diagnosed.
How They occur
Cirrhosis is condition characterized by serious scarring of the liver. These scars can lead to blockages in the liver circulation. The portal vein, which is the vein connecting the stomach, bowel and spleen to the liver is responsible for transporting 1500 ml of blood per minute from these organs to the liver. Any blockage inevitably leads a back flow of blood into the blood vessels of the stomach, bowel and spleen resulting in an increase in pressure within these blood vessels and the portal vein. The result is abnormally distended veins or varices which can occur in the stomach, esophagus and intestines.
Beta Blockers' Effect
According to a study in the New England Journal of medicine, "beta blockers decrease the blood pressure in the portal vein and prevent variceal haemorrhage." They do not prevent varices from occurring.
Recommendations
U.S. government guidelines for the prevention of variceal bleeds recommends that all patients with cirrhosis should be routinely screened for varices. If you are diagnosed with varices, you should be prescribed non-selective beta blockers. If you have already had a bleed, the report also recommends that you be prescribed non-selective beta blockers after recovery to prevent it from happening again. The dose should be adjusted to the maximum dose that you can tolerate.
Speak to your doctor if this is the case and report any side effects so that the dose can be adjusted for your safety. Of course, non-selective beta blockers are only recommended if there are no contraindications. If you have cirrhosis of the liver, but your screening tests show that you do not have varices, there is no need to take non-selective beta blockers.
Heart-Related Side Effects
These include an abnormally slow heart rate, heart failure, heart block, abnormally low blood pressure and a decreased exercise capacity.
Other Side Effects
These are less common and include tightening of the airways in the lungs leading to difficulty breathing, low blood sugar (hypoglycemia), nausea, diarrhea, cold hands and feet fatigue sexual dysfunction dizziness, hallucinations, nightmares, risk of diabetes and depression.
Considerations
Because of the side effects, beta blockers are not recommended for people with asthma or any other disease of the airways, so if you are asthmatic, please discuss alternative options with your doctor. Care is advised if you are diabetic, so again, please discuss with your doctor and always report any side effects you may experience.
