Treatments for Primary Prevention of Esophageal Variceal Bleeding Compared

Nonselective beta-blocker monotherapy appears to reduce the risk of first variceal bleeding
Nonselective beta-blocker monotherapy appears to reduce the risk of first variceal bleeding

For cirrhotic patients with large esophageal varices and no prior history of bleeding, treatment with nonselective beta‐blockers (NSBB) may decrease all-cause mortality and the risk of first variceal bleeding, according to a review published in the journal Hepatology

To compare the effectiveness of various therapeutic approaches for primary prevention of esophageal variceal bleeding, researchers analyzed 32 randomized control trials that included 3362 cirrhotic adults with large esophageal varices and no prior history of bleeding who had a minimum follow-up of 12 months. Treatments (NSBB, isosorbide mononitrate, carvedilol, variceal band ligation) were compared as monotherapy or as combination therapy with each other or versus placebo.

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Results showed moderate quality evidence in favor of NSBB either alone (0.70; 0.49-1.00) or in combination with variceal band ligation (0.49; 0.23-1.02) or isosorbide mononitrate (0.44; 0.21-0.93) for reducing all-cause mortality in these patients. With regard to primary prevention of variceal bleeding, moderate quality evidence supported treatment with carvedilol (0.21; 0.08-0.56) and variceal band ligation alone (0.33; 0.19-0.55) or in combination with NSBB (0.34; 0.14-0.86), while NSBB monotherapy (0.64; 0.38-1.07) was supported by low quality evidence. 

Based on the findings, the authors concluded that NSBB "may be the preferred initial approach for primary prophylaxis of esophageal variceal bleeding," as the treatment decreased all-cause mortality and the risk of first variceal bleeding. In addition, NSBB was associated with a reduced risk of serious complications when compared to variceal band ligation.

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