Beta-Adrenergic–Antagonist Drugs in the Prevention of Gastrointestinal Bleeding in Patients with Cirrhosis and Esophageal Varices

Abstract Background. The value of beta-adrenergic—antagonist drug therapy for the prevention of initial episodes of gastrointestinal bleeding in patients with cirrhosis and esophageal varices is uncertain, both positive and negative study results having been reported. Methods. In this study, we analyzed data on individual patients from four randomized, controlled trials to assess the efficacy of this treatment. Of the 589 patients studied, 286 received a beta-adrenergic—antagonist drug (propranolol in 203 and nadolol in 83) and 303 received placebo. Results. After two years, the mean (±SE) percentage of patients who had had no upper gastrointestinal bleeding was 78±3 percent in the beta-adrenergic—antagonist treatment group and 65±3 percent in the control group (P = 0.002). The percentage of patients without fatal bleeding was 90±2 percent in the treatment group and 82±3 percent in the control group (P = 0.01). The percentage of patients surviving after two years was 71 ±3 percent in the treatment group a...