Could beta blockers be used in th treatment of cirrhotic ascites? the role of serum-ascites albumin gradient estimation

ABSTRACT

This study included 30 portal hypertensive cirrhotic ascitic patients assigned into 3 groups of 10 patients each, well matched as regards age and sex. Groups I, II and III were put on diuretics, beta blocker propranolol, and both, respectively, and restudied 1 month latter. Serum-ascites albumin gradient [S-AAG] was found to correlate positively with grade of esophageal varices and portal vein diameter [P <0.001] and the reduction of portal blood flow [P <0.05]. Diuretics with or without beta blockers propranolol gave a good therapeutic response as regards body weight [P <0.001], 24-hour urine output [P <0.001] and sodium excretion [P <0.05], whereas propranolol alone was found to have deleterious effect on ascites. There was a decrease in renal blood flow in the 3 groups which was more by the use of propranolol. It was concluded that S-AAG is a good predictor of portal hypertension and its response to beta blockers. The portal hypotensive effect of beta blockers showed no beneficial effect on ascites for renal hemodynamic changes resulting in less water and sodium excretion