Short summary

For decades beta-blockers have been a cornerstone in the standard treatment of patients with liver cirrhosis and esophageal varices.  However, in recent years questions regarding the safety and possible contraindications in advanced cirrhosis have been raised based on observational studies, consequently the complexity of the treatment of cirrhotic patients has increased.  No guidelines take these possible contraindications into account and the decision depends on the individual clinician.  This survey aims to unravel clinical practice within this field.

Rationale

Patients with cirrhosis may develop oesophegal varices, which can be followed by complications such as bleeding due to the increased portal pressure. Recommended standard treatment relates to lowering of the portal pressure, generally this goal is obliged by prescribing beta-blockers.

However, new studies question the safety of beta-blockers in advanced cirrhosis. Beta-blockers should be considered only temporary, due to the risk of decreased organ perfusion on late-state cirrhosis and therefore a "window-hypothesis" has been suggested for treatment with beta-blockers. In this context a lot of possible contraindications have been investigated and discussed with various outcome and conclusions.

Due to this uncertainty, it is to be expected that physicians will act differently when considering contraindications, resulting in different treatment due to the physician subjective opinion. Before implementing contraindications in treatment-guidelines, unambiguousness is mandatory which can only be obtained with a randomized controlled trial (RCT).

The aim of this survey is to describe how this new knowledge, affect treatment and perception among this group of patients.

The survey "Beta-blockers in advanced cirrhosis: A local and global survey to unravel impact of conflicting evidence on clinical practice" is structured upon the before mentioned possible contraindications and include questions regarding how the physicians act when deciding "to block or not to block".

Description of the cohort

The survey applies to physicians who treat patients with cirrhosis.

It will be send electronically to:

1. Members of Dansk Selskab for Gastroenterologi og Heptaologi (DSGH) - 350 Danish doctors
2. Members of the Belgian Association for the Study of The liver (BASL) - 400 Belgian doctors
3. Members of the international Club of Ascites (ICA) - 200 members from all over the world
4. Other international organizations that will collaborate

Data and biological material

The purpose of the survey is to collect information of how physicians treat cirrhotic patients.

Collaborating researchers and departments

Department of Medical Gastroenterology, Odense University Hospital

• Professor and Consultant Aleksander Krag, PhD
• Medical Student Katrine Prier Lindvig
• Medical Student Holtz Thorhauge

Department of Liver and Biliopancreatic disorders, University Hospitalt Leuven, Belgium

• Professor Wim Laleman, MD, PhD
• International Club of Ascities,President of ICA and Proffessor Paolo Angeli, Italy
• Proffessor Shiv Sarin, India
• Proffessor Adrian Gadano, Argentina
• Proffessor Ray Kim, USA