Thursday, September 16, 2010

Update on ' Preventing the first variceal bleed'

Previously ..on 08/16/2010, I posted about the prevention of first variceal bleed in patients with cirrhosis, and discussed about benefit of non selective betablockers (NSBB) across the whole spectrum of varices, and compared them with Endoscopic variceal ligation (EVL).
I came across a recent study published in Hepatology published online on Feb 2010, which is a randomised study of NSBB Vs EVL + NSBB for the prevention of first variceal bleed.
They studied around 300 patients with a diagnosis of Cirrhosis mainly due to Hep B/ Hep C(around 60%) & alcohol . They were assigned to one of the two treatment group, and followed for 2 years. There was no statistically significant difference in incidence of first variceal bleed or mortality. But the EVL + NSBB group had to have EVL every 4 weeks in the beginning ..until the obliteration of varices. This met with more complication rates than patients on betablockers alone.
The authors concluded that The addition of ligation to nadolol may increase adverse events and did not enhance effectiveness in the prophylaxis of first variceal bleeding.

A problem that most studies on this subject encountered ..has been the non compliance with medications in this group of people. The authors in this study did mention about some participants abusing alcohol.....and this could have had an effect on the results. In my opinion ....patients non compliant with taking daily medications or in whom NSBB causes side effects might benefit from EVL.


  1. You have given the update on the vertical bleed. As this can be best information for all the persons. Who wants to prevent this problem?

  2. Good question. Well, variceal bleed is the most common clinical manifestation of portal hypertension in patients with liver cirrhosis. Once bleeding occurs in patients with varices 30-50% of patients die within 6 weeks. Among those who survive the first hemorrhage, 47-84% show recurrent bleeding and 70% die within the first year. These are big numbers. If you ask a gastroenterologist, hepatologist, intensivist, or a family member of an alcoholic ...then you might even get a better answer!

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