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Introduction National Institute for Health and Care Excellence (NICE) published guidance on the management of chronic hepatitis B (CHB) in June 2013 (NICE 165). Where antiviral therapy was indicated, NICE recommended 48 weeks Peg-interferon alfa-2a (PegIFNα) as first-line treatment in compensated disease and early discontinuation of PegIFNα based on stopping rules. Nucleos(t)ide analogues were recommended as second-line therapies. This survey was undertaken to capture current CHB practice management across the UK following NICE 165 and report PegIFNα use, and review the availability/utility of quantitative HBsAg. Methods This was a UK-wide national multicentre study, where 25 CHB treatment centres were invited to complete a qualitative questionnaire of CHB practice. Clinical practice in the 12 months preceding NICE 165 was compared with CHB management in the immediate 12 months post publication. Results All centres participating undertook a multi-disciplinary approach to the treatment of CHB patients, with 75% of centres adopting joint consultant-nurse led clinics. Interim analysis of the data revealed that 73% of centres consider PegIFNα as first line therapy in eAg+ disease, compared with 40% in eAg- disease. Importantly, there was no difference in the use of PegIFNα, irrespective of eAg status, prior to and following the publication of NICE 165 (p = 0.82). Of those patients treated with PegIFNα as first line-therapy, 63% of them, to date, required second line therapy with NUCs due to treatment failure. Conclusion This UK survey demonstrates that current practice has not significantly changed following NICE 165. While most centres adopt a multi-disciplinary approach, the UK guidance on CHB has not been widely adopted. Barriers to this may include the limited availablilty of qHBsAg in UK centres, but more likely this relates to Physician preference for the continued use of NUCs as first-line therapy of choice. Disclosure of Interest N. Hansi: None Declared, P. Trok, None Declared, U. Gill: None Declared, K. Agarwal: None Declared, M. Aldersley: None Declared, S. Al-Shamma: None Declared, A. Brown: None Declared, J. Cobbold: None Declared, P. Collins: None Declared, A. Fowell: None Declared, W. Gelson: None Declared, A. Holt: None Declared, S. McPherson: None Declared, M. Phillips: None Declared, M. Prince: None Declared, P. Richardson: None Declared, S. Ryder: None Declared, S. Singhal: None Declared, B. Stone: None Declared, A. Ustianowski: None Declared, J. Vilar: None Declared, L. Walker: None Declared, T. Wong: None Declared, P. Kennedy Grant/research support from: Gilead Sciences

Introduction A recent study suggesting β-blockers should be contra-indicated in cirrhotic patients with refractory ascites has gained significant attention. 1 We sought to examine this hypothesis in a cohort of patients undergoing elective paracentesis in a tertiary liver unit. Methods We retrospectively studied 114 consecutive patients undergoing regular paracentesis between July 2007 and December 2010 at Addenbrooke9s Hospital. 36 patients were maintained on propanolol for variceal prophylaxis, whereas 78 were not β-blocked. Mortality and morbidity were compared between the two groups. The χ 2 , Mann–Whitney and Kaplan–Meier methods were employed for statistical analysis. Results There was no statistically significant difference between the two groups in terms of age, sex, aetiology of liver disease (predominantly alcohol), Child-Pugh score and UKELD. Hepatocellular carcinoma was present in 16% of patients in the propanolol group and 13% of the non β-blocked group (p=0.62). Varices were predictably present more in the propanolol group compared with the non β-blocked group (97% vs 59%, p Conclusion This study demonstrates that propanolol used in a total daily dose of between 40 and 80 mg is safe in patients with cirrhosis and refractory ascites. Deleterious effects at higher doses cannot be excluded. Notwithstanding this limitation and the retrospective nature of the analysis, these data reassure regarding the use of β-blockers in this patient group and that such drugs should not be immediately contraindicated. Competing interests None declared. Reference 1. Serste T , Melot C, Francoz C, et al . Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology 2010; 52 :1017–22.

Introduction Variceal haemorrhage is a common, life-threatening complication of portal hypertension. In this study, we aim to assess mortality and predictors of outcome in a cohort of patients presenting acutely with a bleed. Methods We performed a retrospective review of consecutive cases of oesophageal variceal haemorrhage presenting acutely to our centre (a regional Hepatology Unit) in 2008. 30 cases were identified. Median age was 52 (range 29–79), 14 (46.7%) patients were male and underlying liver disease aetiology was alcohol-related in 15 (50%). The Mann–Whitney U test was used to compare United Kingdom Model for End-Stage Liver Disease and Model for End Stage Liver Disease (UKELD and MELD, respectively) scores at presentation by mortality. Receiver operating characteristic (ROC) curves were plotted when significant associations with UKELD and MELD scores were found. Binary logistic regression analyses were used to assess for associations with re-bleeding and death. Results 30-day mortality from admission to hospital was 13.3%, 90-day 30.0% and 180-day 40.0%. 7 (23.3%) patients had more than one bleed. Rescue TIPS shunt was required in 3 (10%). UKELD score at presentation was significantly higher in those who died within 30 days (mean 51.9 vs 60.6, p=0.02), but not thereafter. A similar finding for 30-day mortality was observed with MELD score (5.8 vs 20.5, p Univariate binary regression analyses identified positive associations of gender, creatinine and sodium with death, and ALD, bilirubin and creatinine with re-bleeding (p Conclusion This study confirms a high mortality in patients presenting with variceal haemorrhage. UKELD and MELD scoring systems show promise at stratifying risk in this cohort.