Cirrhosis has become a leading cause of death in the United States and worldwide owing the increased prevalence of alcoholic liver disease, hepatitis C, and more recently, non-alcoholic steatohepatitis and non-alcoholic fatty liver disease. Beta-blockers have been proven to be efficacious in primary, as long as secondary prophylaxis of variceal bleeding, more than 35 years ago. Nonetheless, recent data has cautioned the use of beta-blockers in patients with end-stage cirrhosis and refractory ascites suggesting increased mortality from beta-blockers in this group of patients. In this article, we will discuss this topic in details, and review the conflicting studies about beta-blockers in cirrhosis, and try to provide logical suggestions concerning the use of this class of medication in patients with cirrhosis.
