title: Primary prophylaxis of variceal bleeding.
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.
authors.affiliation: Gastroenterology Research Unit, Division of Gastroenterology and Hepatology, Department of Physiology, Advanced Liver Disease Study Group, Fiterman Center for Digestive Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Simonetto
authors.affiliation: Gastroenterology Research Unit, Division of Gastroenterology and Hepatology, Department of Physiology, Advanced Liver Disease Study Group, Fiterman Center for Digestive Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
authors.forename: Vijay H
authors.initials: VH
authors.lastname: Shah
authors.affiliation: Gastroenterology Research Unit, Division of Gastroenterology and Hepatology, Department of Physiology, Advanced Liver Disease Study Group, Fiterman Center for Digestive Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. Electronic address: kamath.patrick@mayo.edu.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D004932:Esophageal and Gastric Varices / Q000188:drug therapy / Q000517:prevention & control* / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008026:Ligation; D017082:Portal Pressure / Q000187:drug effects; D011322:Primary Prevention; D011412:Propanolamines / Q000627:therapeutic use; D012307:Risk Factors
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol
keywords: Cirrhosis; Endoscopy; Gastrointestinal hemorrhage; Portal hypertension; β-blockers