Editor-in-Chief & Deputy Editor 2019-2021





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Prophylaxis of first variceal bleeding

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In spite of significant improvements in treatment, the mortality of a first variceal haemorrhage in patients with cirrhosis remains high. The best way to avoid this, is prevention. Therefore all cirrhotic patients should be screened for the presence of varices at the time of the initial diagnosis of cirrhosis. Today ß-blockers cannot be recommended for the pre-primary prevention of development of gastrooesophageal varices in patients, in contrast to what was suggested by studies in rats with portal hypertension. In case of large varices, non-selective ß-blockers such as propranolol and nadolol have to be started and recent data support the idea of indefinite treatment. Data are missing about the primary prevention of variceal bleeding in case of gastric varices. At present there is no indicatation for monotherapy with nitrates. Combination with ß-blockers and nitrates can not be recommended in all patients because of the possible side-effects of nitrates, especially in patients with older age and tense ascites. Combination therapy should therefore currently be restricted to patients with no response to ß-blockers. The best way to assess this is via haemodynamic monitoring, although the exact methods still have to be clarified. In case of intolerance or contra-indication for ßblockers, endoscopic variceal ligation can be performed until variceal obliteration, although this approach has also to be further explored. [Product Details...]