Gastrointestinal varices primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Primary prevention of variceal bleeding may be achieved via rigorous surveillance of varices after their development and via the use non-selective beta blockers and/or endoscopic band ligation (EBL). Liver disease is the most common cause of portal hypertension and effective measures for the primary prevention of liver diseases include hepatitis B vaccination, avoidance from unprotected sexual intercourse, precise screening of the blood products before infusion, reducing alcohol consumption, obesity prevention, and diabetes mellitus prevention.

Primary Prevention

• Effective measures to prevent variceal bleeding include the following:

Cirrhosis

• Diagnostic endoscopy for the presence of varices

No varices

• Surveillance for development of varices (every 2-3 yr in compensated cirrhosis/yearly in cases of decompensation)

Small varices-low bleeding risk

• Surveillance for progression of varices (every 1-2 yr in compensated cirrhosis/yearly in cases of decompensation)

Small varices-high bleeding risk

• Non-selective beta blockers

Medium-large varices

• Non-selective beta blockers or endoscopic band ligation (EBL)
• There are no established measures for the primary prevention of portal hypertension.
• Effective measures for the primary prevention of liver diseases, as the main causes of portal hypertension, include:
  • Prevention of hepatitis B through vaccination
  • Avoid unprotected sexual intercourse
  • Prevention of hepatitis C through precise screening of the blood products before infusion
  • Reduction of alcohol consumption
  • Prevention of overweight and obesity
  • Prevention of diabetes mellitus