Primary Prevention of Bleeding from Oesophageal Varices

Variceal bleeding is the most serious complication of patients with cirrhosis and portal hypertension. Mortality related to variceal bleeding has been falling in recent years but is still considered among the leading causes of death in these patients. Therefore, the issue of primary prophylaxis of variceal bleeding is an important one. In the pre-primary prophylaxis setting (prevention of formation/growth of varices) all cirrhotics should be screened for varices at diagnosis although there is no currently indication for treating patients in order to prevent the formation of varices. Areas requiring further study include the natural history of low-risk varices and treatment possibilities for the decrease or the prevention of the development and/or the progression of varices. Patients with small varices could be treated with beta-blockers, which have been proved effective in reducing the risk of first variceal bleeding in patients with medium and large oesophageal varices. Endoscopic band ligation seems to be more effective in recent trials, but concerns have been raised regarding its safety. Further, studies are required to clarify whether the use of the combination of band ligation and beta-blockers is better than each treatment alone. The future aim is to improve current medical therapy taking into consideration the cost-effectiveness and the quality of life