Oesophageal varices in cirrhotic patients: from variceal screening to primary prophylaxis of the first oesophageal variceal bleeding

Authors

  • Chunqing Zhang,

    1. Department of Gastroenterology, Provincial Hospital Affiliated to Shandong University, Jinan Shandong, China
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  • Dominique Thabut,

    1. Gastroenterology Research Unit, Advanced Liver Disease Study Group, Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, MN, USA
    2. AP-HP, Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
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  • Patrick S. Kamath,

    1. Gastroenterology Research Unit, Advanced Liver Disease Study Group, Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, MN, USA
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  • Vijay H. Shah

    1. Gastroenterology Research Unit, Advanced Liver Disease Study Group, Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, MN, USA
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Correspondence
Vijay H. Shah, Gastroenterology Research Unit, Advanced Liver Disease Study Group, Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, MN, USA.
Tel: 507-255-6028
Fax: 507-255-6318
e-mail: shah.vijay@mayo.edu

Abstract

Bleeding from oesophageal varices is still a lethal complication in cirrhotic patients with portal hypertension. Approximately 5–10% of patients with cirrhosis will develop oesophageal varices per year, and about 25–30% of cirrhotic patients with oesophageal varices and without previous variceal haemorrhage will bleed from ruptured varices. To date, data on preventing the formation/growth of oesophageal varices (preprimary prophylaxis) are conflicting, with insufficient evidence to use β-blockers. There is evidence for the need for primary prophylaxis, and both β-blockers and endoscopic variceal ligation have shown the same efficacy in preventing first bleeding, but which one to prefer is still controversial. The present article reviews the established and potential therapeutic strategies for preventing the development and rupture of oesophageal varices.

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