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Primary and pre-primary prophylaxis against variceal hemorrhage in patients with cirrhosis

Author
Arun J Sanyal, MD
Section Editor
Bruce A Runyon, MD
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

Approximately half of patients with cirrhosis have esophageal varices, and one-third of all patients with varices will develop variceal hemorrhage, a major cause of morbidity and mortality in patients with cirrhosis [1,2]. The risk of hemorrhage has been related to the size and appearance of the varices, as well as the degree of hepatic dysfunction. (See "Prediction of variceal hemorrhage in patients with cirrhosis".)

Primary prophylaxis aims to prevent variceal hemorrhage in patients with esophageal varices who do not have a history of hemorrhage. Pre-primary prophylaxis refers to measures aimed at preventing the development of varices. Measures aimed at preventing hemorrhage in patients with a history of variceal hemorrhage are referred to as secondary prophylaxis.

An ideal treatment of portal hypertension would be one that is universally effective, safe, easy to administer, and cost-effective. While such a treatment does not currently exist, there are several medical and surgical modalities available for primary prophylaxis of variceal hemorrhage. These therapies are aimed at achieving one of the following results:

Decreasing portal hypertension (eg, beta blockers, surgical portal decompression, or transjugular intrahepatic shunts)

Treating the varices directly (eg, variceal ligation)

                            

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Literature review current through: Nov 2016. | This topic last updated: Mon Nov 02 00:00:00 GMT+00:00 2015.
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