Variceal bleeding. Can it be prevented?

Esophageal and gastric varices develop as a consequence of portal hypertension and advanced chronic liver disease. Bleeding from these varices causes high mortality and morbidity. The exact mechanism leading to rupture of varices is unknown, but portal pressure, intravariceal pressure, and increased variceal wall tension may be factors. Large varices are most likely to bleed, and some studies suggest that red wales on varices may predict bleeding risk. Surgery and endoscopic sclerotherapy are not useful for preventing initial variceal bleeding, but nonselective beta-adrenergic blocking drugs have been shown to be beneficial in primary prophylaxis. Proper selection of patients and careful monitoring of side effects during treatment enhance successful outcomes.