Editorial DeskFrom the Editor's desk...: March 2016

Selection of the monthNon-selective beta blockers (NSBBs) improve the survival of ACLF patientsNSBBs have been the mainstay of pharmacological therapy for portal hypertension in cirrhotic patients for over 25 years. Data in the past few years have indicated that mortality of patients with refractory ascites or spontaneous bacterial peritonitis may be increased if NSBBs are continued. The important paper by Mookerjee et al. analyses the data obtained in the prospective observational study in patients with acute deterioration of cirrhosis requiring hospital admission: the CANONIC study. The results show that the patients that were being treated with NSBBs at the time of hospital admission with ACLF had a significantly lower mortality, which was associated with a less severe inflammatory response. However, the doses of NSBBs used were relatively low suggesting that the protective effect may be due to mechanisms other than its known hemodynamic effects. The data argues against stopping NSBBs in cirrhotic patients unless there are specific contraindications.