Use of ß-blocker therapy to prevent primary bleeding of esophageal varices.
OBJECTIVE
The purpose of this article is to educate nurse practitioners about the pathophysiology surrounding the development of portal hypertension and the effective use of nonselective ß-blockers to prevent primary bleeding and decrease the mortality risk.


METHODS
The articles included were retrieved via ISI Web of Science using the years 2004-2009 and key words cirrhosis, portal hypertension, esophageal varices, and beta-blockers. This information included scholarly books, journal reviews, retrospective chart reviews, and prospective randomized studies.


CONCLUSIONS
Cirrhosis is the leading cause of portal hypertension in Europe and North America. Esophageal varices are a result of the portosystemic collaterals the body develops to decompress the portal system. Hemorrhage from esophageal varices is a major cause of morbidity and mortality. Prevention of a primary bleed is the goal of therapy and is accomplished with nonselective ß-blockers.


CONCLUSIONS
Very few patients with portal hypertension and esophageal varices are on ß-blockers. Use of nonselective ß-blockers has been found to lower portal pressure and decreases the risk of bleeding from esophageal varices and therefore decreases mortality. Patients unable to use ß-blockers can undergo endoscopic variceal ligation as an alternate method to reduce risk of bleeding.
Endoscopy Department, Hospital of the University of Pennsylvania, Philadelphia, USA. tammy.tursi@uphs.upenn.edu
Tammy
T
Tursi
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000465:Algorithms; D015984:Causality; D003663:Decision Trees; D016903:Drug Monitoring; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis; D009722:Nurse Practitioners; D024802:Nurse's Role; D018579:Patient Selection; D011322:Primary Prevention / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists