Dr. Michael Colletti
Purpose: The purpose of this clinical review article is to demonstrate the benefits of prophylactic treatment with beta-blockers for the prevention of recurrent esophageal variceal bleeding in patients with cirrhosis.
Method: A PubMed literature search of English-language articles was conducted with search key terms “esophageal varices/variceal,” “varix hemorrhage,” “variceal bleeding”, “prophylaxis with beta blockers,” “complications of cirrhosis,” “treatment of varices,” “endoscopic variceal ligation (EVL), “hepatic cirrhosis,” “portal hypertension,” “NSBB,” “burden of variceal bleeding.” The author identified twenty-three pertinent articles/publications for inclusion in this clinical review with use of retrieved article reference lists. Selections were based on relevance to the focused topic and served as the basis for this clinical review; many were excluded either due to irrelevance or a date of publish over 10 years ago.
Results: Multiple evidence based research studies include, peer review articles, systematic reviews, observational studies, and meta-analysis studies. Overall, concurring results demonstrate superior therapeutic management in the prevention of recurrent esophageal variceal bleeding with beta blockers.
Conclusion: Nonselective Beta Blockers (NSBB) have been the cornerstone of treatment for esophageal variceal bleeding for several decades. The goal of treatment is not only to control acute hemorrhaging with primary prophylaxis, but more importantly to prevent re-bleeding necessitating secondary prophylaxis to prevent patient decompensation and death. Therefore, prevention of variceal hemorrhaging begins with proper screening of all patients with cirrhosis. Over one-third of patients will have esophageal varices and up to 50% are likely to experience variceal hemorrhage with up to 75% likely to have future variceal bleeding episodes without proper management. The effects of daily NSBB with propranolol dosed between 40mg and 80mg has proven to increase survival rates with a 45% reduction in mortality.
"Prevention of Recurrent Esophageal Variceal Bleeding in Patients with Cirrhosis,"
Lynchburg Journal of Medical Science: Vol. 1
, Article 57.
Available at: https://digitalshowcase.lynchburg.edu/dmscjournal/vol1/iss3/57
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