Primary prophylaxis of esophageal variceal bleeding in cirrhosis.
Variceal bleeding is a common and severe complication of liver cirrhosis. The risk of bleeding increases with the size of varices, red wheal marks and disease severity. Noninvasive tests are not accurate enough for the diagnosis of varices, so all patients with cirrhosis should be screened by endoscopy. Nonselective beta-blockers (propranolol, nadolol) are indicated for primary prophylaxis in patients with medium/large varices, and for those with small varices and red signs or advanced liver failure (Child C). In such patients, beta-blockers have been shown to reduce the risk of bleeding from 25 to 15%. There is no evidence to support using beta-blockers with nitrates or spironolactone. In patients with contraindication or intolerance to beta-blockers, endoscopic band ligations are indicated.
Bellot
P
P
Hepatic Hemodynamic Laboratory and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Liver Unit, IMD, Hospital Clinic, IDIBAPS, University of Barcelona, C. Villarroel 170, 08036 Barcelona, Spain.
García-Pagán
J C
JC
Abraldes
J G
JG
Bosch
J
J
D003663:Decision Trees; D004932:Esophageal and Gastric Varices / Q000150:complications*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D012307:Risk Factors