Variceal rebleeding frequently develops in patients with cirrhosis after an initial episode of acute variceal hemorrhage. The best prophylactic treatment for variceal rebleeding has not been clearly identified. Several studies have been performed to determine an optimal approach but no agreement exists about how best to treat these patients.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Pagliaro, L. et al. in Portal Hypertension: Pathophysiology and Treatment (eds Bosch, J. & Groszmann, R.J.) 72–92 (Blackwell, Oxford, 1994).
Lebrec, D. & Stiegmann, G. In Portal Hypertension III. Proceedings of the Third Baveno International Consensus Workshop on Definitions, Methodology & Therapeutic Strategy (ed. de Franchis, R.) 170–179 (Blackwell, Oxford, 2001).
D'Amico, G., Pagliaro, L. & Bosch, J. Pharmacological treatment of portal hypertension: an evidence-based approach. Semin. Liver Dis. 19, 475–505 (1999).
Gournay, J., Masliha, C., Martin, T., Perrin, D. & Galmiche, J. P. Isosorbide mononitrate and propanolol compared with propranolol alone for the prevention of variceal rebleeding. Hepatology 31, 1239–1245 (2000).
de Franchis, R. Updating consensus in portal hypertension: report of the Baveno III consensus workshop on definitions, methodology and therapeutic strategies in portal hypertension. J. Hepatol. 33, 846–852 (2000).
Laine, L., el Newihi, H. M., Migikovsky, B., Sloane, R. & Garcia, F. Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices. Ann. Intern. Med. 119, 1–7 (1993).
Lo, G. et al. Endoscopic variceal ligation plus nadolol and sucralfate compared with ligation alone for the prevention of variceal rebleeding: a prospective, randomized trial. Hepatology 32, 461–465 (2000).
de la Peña, J. et al. Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: a multicenter trial. Hepatology 41, 572–578 (2005).
Gonzales, R. et al. Meta-analysis: combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis. Ann. Intern. Med. 149, 109–122 (2008).
Garcia-Pagan, J. C. et al. Nadolol plus isosorbide mononitrate alone or associated with band ligation in the prevention of variceal rebleeding: a multicentre randomized controlled trial. Gut 58, 1144–1150 (2009).
Kumar, A. et al. Addition of propranolol and isosorbide mononitrate to endoscopic variceal ligation does not reduce variceal rebleeding incidence. Gastroenterology 137, 892–901 (2009).
Burroughs, A. K. et al. In Portal Hypertension IV. Proceedings of the Fourth Baveno International Consensus Workshop on Definitions, Methodology & Therapeutic Strategy (ed. de Franchis, R.) 11–39 (Wiley-Blackwell, Oxford, 2006).
Author information
Authors and Affiliations
Ethics declarations
Competing interests
The author declares no competing financial interests.
Rights and permissions
About this article
Cite this article
Kravetz, D. Secondary prophylaxis for variceal bleeding. Nat Rev Gastroenterol Hepatol 7, 10–11 (2010). https://doi.org/10.1038/nrgastro.2009.216
Issue Date:
DOI: https://doi.org/10.1038/nrgastro.2009.216
