Primary prophylaxis of variceal bleeding

Clin Liver Dis. 2014 May;18(2):335-45. doi: 10.1016/j.cld.2013.12.005. Epub 2014 Feb 25.

Abstract

Primary prevention of variceal bleeding is an important and long-debated topic in the management of patients with cirrhosis and esophageal varices. Prophylaxis is recommended for high-risk patients with small esophageal varices (advanced liver disease and/or presence of red wale marks) and those with medium/large varices. Nonselective β-blockers and endoscopic band ligation have been shown to be equally effective in primary prevention of variceal bleeding and are the only currently recommended therapies. Controversy still exists, however, regarding which one of these strategies is preferred. This article reviews the established recommendations and recent advances in the prevention of first esophageal variceal bleeding.

Keywords: Cirrhosis; Endoscopy; Gastrointestinal hemorrhage; Portal hypertension; β-blockers.

Publication types

  • Review

MeSH terms

  • Adrenergic alpha-1 Receptor Antagonists / therapeutic use
  • Adrenergic beta-Antagonists / therapeutic use
  • Carbazoles / therapeutic use
  • Carvedilol
  • Esophageal and Gastric Varices / drug therapy
  • Esophageal and Gastric Varices / prevention & control*
  • Esophageal and Gastric Varices / surgery
  • Gastrointestinal Hemorrhage / prevention & control*
  • Humans
  • Ligation
  • Portal Pressure / drug effects
  • Primary Prevention
  • Propanolamines / therapeutic use
  • Risk Factors

Substances

  • Adrenergic alpha-1 Receptor Antagonists
  • Adrenergic beta-Antagonists
  • Carbazoles
  • Propanolamines
  • Carvedilol