The effect of beta-blockers on bacterial translocation in cirrhosis
Research type
Research Study
Full title
The effect of non-selective beta-blockers on gastrointestinal motility, intestinal permeability and bacterial translocation in patients with cirrhosis
IRAS ID
321352
Contact name
Emmanuel Tsochatzis
Contact email
Sponsor organisation
University College London
Duration of Study in the UK
4 years, 0 months, 1 days
Research summary
Mortality from liver disease has continued to rise over the past three decades. As liver disease progresses and causes cirrhosis (an accumulation of scar tissue in the liver cells) an increased pressure on the liver veins and surrounding blood vessels occurs, named portal hypertension. This is responsible for the severe symptoms of cirrhosis including the accumulation of fluid in the stomach and bleeding from the gullet. Once these occur, a patient’s quality of life is drastically reduced, they have a higher risk of infection and of dying.
During cirrhosis patients have defects in their innate immunity and additionally have a leaky gut. Combined, these factors increase the risk of bacteria transferring from the gut into the mesenteric lymph nodes and the circulation, termed bacterial translocation. Recent evidence has shown that the presence of these bacteria and their products further worsens portal hypertension.
Non-selective beta-blockers are a group of drugs commonly used to treat portal hypertension to reduce the risk of bleeding from the gullet. Research has shown they increase survival beyond reducing bleeding and suggests they may improve the motility and leakiness of the gut and therefore reduce bacterial translocation. We aim to assess and quantify these potential effects by studying various parameters.
We will study two patient groups; one who are starting beta-blockers and a second group (for comparison) who are due to undergo a transjugular intrahepatic portosystemic shunt (TIPSS) which reduces portal hypertension but has no effect on bowel motility. Tests additional to the patient’s routine clinical care will include blood, urine and stool samples, measurements of intestinal permeability and small bowel cineMRI.
If a significant effect is found, we aim to use these data as the basis to conduct a randomised controlled study investigating the effect on primary and secondary prevention of infection after early initiation of beta-blockade.
REC name
East Midlands - Nottingham 1 Research Ethics Committee
REC reference
24/EM/0253
Date of REC Opinion
18 Feb 2025
REC opinion
Further Information Favourable Opinion