The cirrhotic patient with no varices and with small varices
The history of treatment of portal hypertension is characterized by a progressive tendency to treat patients in earlier stages of the disease. Indeed, in the beginning, treatment of portal hypertension was limited to treatment of acute bleeding and prevention of recurrent variceal bleeding; from the end of the 1980s it was shown that patients with high-risk varices but without previous bleeding are good candidates for a pharmacologic prophylaxis (and in some instances for an endoscopic prophylaxis). Recent research has been devoted to investigating whether prophylaxis of variceal bleeding should be started early, when varices are not yet present (in order to prevent varices formation), or when small varices with low risk of bleeding are seen, in order to decrease the risk of growth of varices and eventually the risk of variceal bleeding 1. This area of research, sometimes called “pre-primary prophylaxis”, is the background on which the clinical decisions on single patients with cirrhosis without varices or with small varices should be made.
KeywordsPortal Hypertension Cirrhotic Patient Esophageal Varix Variceal Bleeding Portal Pressure
Unable to display preview. Download preview PDF.
- 1.Merkel C, Escorsell A, Sieber CC, Lee FY, Groszmann RJ. Pre-primary prophylaxis: can (and should) we prevent the formation and growth of varices? In: de Franchis R, editor. Portal Hypertension III. Oxford: Blackwell, 2001:97–111.Google Scholar
- 4.Zuin R, Gatta A, Merkel C et al. Evaluation of peritoneoscopic and oesophagoscopic findings as indexes of portal hypertension in patients with liver cirrhosis. Ital J Gastroenterol. 1982;14:214–19.Google Scholar
- 6.Colombato LA, Albillos A, Genecin P. Prevention of portal-systemic shunting in propranolol-treated and in sodium-restricted cirrhotic rats. Gastroenterology. 1991;100:A730.Google Scholar
- 10.Pagliaro L, D’Amico G, Pasta L et al. Portal hypertension in cirrhosis: natural history. In: Bosch J, Groszmann RJ, editors. Portal Hypertension: Pathophysiology and Treatment. Oxford: Blackwell, 1994:72–92.Google Scholar
- 12.Groszmann RJ, Garcia-Tsao G, Makuch R et al. Multicenter randomized placebo-controlled trial of non-selective beta-blockers in the prevention of the complications of portal hypertension: final results and identification of a predictive factor. Hepatology. 2003;38 (Suppl. 1):206 (abstract).Google Scholar
- 22.Merkel C, Angeli P, Marin R et al. Beta-blockers in the prevention of aggravation of esophageal varices in patients with cirrhosis and small esophageal varices. interim analysis of a controlled clinical trial. Hepatology. 1998;28(Suppl. 1):453A (abstract).Google Scholar