{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:44:46Z","timestamp":1787013886628,"version":"build-2736575974"},"reference-count":101,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T00:00:00Z","timestamp":1674518400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Advanced chronic liver disease is an increasing cause of premature morbidity and mortality in the UK. Portal hypertension is the primary driver of decompensation, including the development of ascites, hepatic encephalopathy and variceal haemorrhage. Non\u2010selective beta blockers (NSBB) reduce portal pressure and are well established in the prevention of variceal haemorrhage. Carvedilol, a newer NSBB, is more effective at reducing portal pressure due to additional \u03b1\u2010adrenergic blockade and has additional anti\u2010oxidant, anti\u2010inflammatory and anti\u2010fibrotic effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To summarise the available evidence on the use of beta blockers, specifically carvedilol, in cirrhosis, focussing on when and why to start<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a comprehensive literature search of PubMed for relevant publications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>International guidelines advise the use of NSBB in primary prophylaxis against variceal haemorrhage in those with high\u2010risk varices, with substantial evidence of efficacy comparable with endoscopic band ligation (EBL). NSBB are also well established in secondary prophylaxis, in combination with EBL. More controversial is their use in patients without large varices, but with clinically significant portal hypertension. However, there is gathering evidence that NSBB, particularly carvedilol, reduce the risk of decompensation and improve survival. While caution is advised in patients with advanced cirrhosis and refractory ascites, recent evidence suggests that NSBB can continue to be used safely, and that premature discontinuation may be detrimental.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>With increasing evidence of benefit independent of variceal bleeding, namely retardation of decompensation and improvement in survival, it is time to consider whether carvedilol should be offered to all patients with advanced chronic liver disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.17380","type":"journal-article","created":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T05:14:33Z","timestamp":1674537273000},"page":"454-463","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Review article: controversies surrounding the use of carvedilol and other beta blockers in the management of portal hypertension and cirrhosis"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1476-9369","authenticated-orcid":false,"given":"Sarah\u2010Louise","family":"Gillespie","sequence":"first","affiliation":[{"name":"Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3682-7400","authenticated-orcid":false,"given":"Timothy P.","family":"Hanrahan","sequence":"additional","affiliation":[{"name":"Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh  Edinburgh UK"},{"name":"Department of Gastroenterology and Hepatology, Austin Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3751-2961","authenticated-orcid":false,"given":"Don C.","family":"Rockey","sequence":"additional","affiliation":[{"name":"Digestive Disease Research Center Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2975-4327","authenticated-orcid":false,"given":"Avik","family":"Majumdar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Austin Health  Melbourne Australia"},{"name":"The University of Melbourne  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9660-8322","authenticated-orcid":false,"given":"Peter C.","family":"Hayes","sequence":"additional","affiliation":[{"name":"Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh  Edinburgh UK"},{"name":"College of Medicine and Veterinary Medicine University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,24]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61838-9"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.10.020"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2005.10.013"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198112033052302"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198710013171403"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(90)91668-Z"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199105303242202"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(96)80296-0"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840050313"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2006.08.017"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(98)70487-1"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2007.03.014"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2011.02579.x"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510240137"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.2353\/ajpath.2007.060887"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1582-4934.2011.01399.x"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20193"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2007.144584"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2003.50133"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1053\/he.2000.6779"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.03.048"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2000.19322"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.456"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2004.01.017"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840050120"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0000000000001293"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14042"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840360612"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1665-2681(19)30849-X"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365521.2012.666673"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2012-304038"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010902"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2022.06.007"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2012.12.011"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13119"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2009.02038.x"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2014.03.005"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.024"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.16490"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v21.i32.9566"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.taap.2012.04.012"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0148868"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.taap.2016.10.012"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.2174\/092986712803341520"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/112_2018_10"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.2.122"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1177\/0960327121999442"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.taap.2019.114750"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2018.08.001"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11011-012-9351-5"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1038\/ctg.2015.38"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pharmthera.2015.11.003"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1427.036"},{"key":"e_1_2_12_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2022.109119"},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejphar.2017.08.013"},{"key":"e_1_2_12_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.10.018"},{"key":"e_1_2_12_58_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-019-09986-9"},{"key":"e_1_2_12_59_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2015-309262"},{"key":"e_1_2_12_60_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28906"},{"key":"e_1_2_12_61_1","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/346705"},{"key":"e_1_2_12_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1665-2681(19)30934-2"},{"key":"e_1_2_12_63_1","unstructured":"MalandrisK.Carvedilol for prevention of variceal bleeding: a systematic review and meta analysis. aog [Internet];2019[cited 2022 Aug 15]; Available from:http:\/\/www.annalsgastro.gr\/files\/journals\/1\/earlyview\/2019\/ev\u201003\u20102019\u201002\u2010AG4456\u20100368.pdf"},{"key":"e_1_2_12_64_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-017-9835-9"},{"key":"e_1_2_12_65_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23045"},{"key":"e_1_2_12_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2013.11.019"},{"key":"e_1_2_12_67_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.12.022"},{"key":"e_1_2_12_68_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.12452"},{"key":"e_1_2_12_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.06.015"},{"key":"e_1_2_12_70_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1746.2012.07244.x"},{"key":"e_1_2_12_71_1","doi-asserted-by":"crossref","unstructured":"HamalAB.Carvedilol versus propranolol for secondary prophylaxis of variceal hemorrhage in patients with liver cirrhosis. ARGH [Internet];2020[cited 2022 Aug 23];15(4). Available from:https:\/\/juniperpublishers.com\/argh\/ARGH.MS.ID.555920.php","DOI":"10.19080\/argh.2020.15.555920"},{"key":"e_1_2_12_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2019.02.021"},{"key":"e_1_2_12_73_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2016-311735"},{"key":"e_1_2_12_74_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2004.05.004"},{"key":"e_1_2_12_75_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-012-9353-8"},{"key":"e_1_2_12_76_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v21.i10.3100"},{"key":"e_1_2_12_77_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.161.21.2564"},{"key":"e_1_2_12_78_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31875-0"},{"key":"e_1_2_12_79_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.3665"},{"key":"e_1_2_12_80_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28824"},{"key":"e_1_2_12_81_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22358"},{"key":"e_1_2_12_82_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.16189"},{"key":"e_1_2_12_83_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.16901"},{"key":"e_1_2_12_84_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.05.021"},{"key":"e_1_2_12_85_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32737"},{"key":"e_1_2_12_86_1","unstructured":"BNF.Propranolol hydrochloride. Contraindications;2022.https:\/\/bnf.nice.org.uk\/drugs\/propranolol\u2010hydrochloride\/#contra\u2010indications"},{"key":"e_1_2_12_87_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28352"},{"key":"e_1_2_12_88_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1007133"},{"key":"e_1_2_12_89_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072\u2010016\u20109765\u2010y"},{"key":"e_1_2_12_90_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.327"},{"key":"e_1_2_12_91_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23775"},{"key":"e_1_2_12_92_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2011-301348"},{"key":"e_1_2_12_93_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13409"},{"key":"e_1_2_12_94_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.14366"},{"key":"e_1_2_12_95_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26676"},{"key":"e_1_2_12_96_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjms.2015.11.018"},{"key":"e_1_2_12_97_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.16156"},{"key":"e_1_2_12_98_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.02.005"},{"key":"e_1_2_12_99_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2013-306502"},{"key":"e_1_2_12_100_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-019-1155-1"},{"key":"e_1_2_12_101_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2019.05.050"},{"key":"e_1_2_12_102_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.05.011"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.17380","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/apt.17380","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.17380","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T10:41:37Z","timestamp":1692268897000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.17380"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,24]]},"references-count":101,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023,3]]}},"alternative-id":["10.1111\/apt.17380"],"URL":"https:\/\/doi.org\/10.1111\/apt.17380","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,24]]},"assertion":[{"value":"2022-10-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}