Gastrointestinal varices primary prevention

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

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.

Effective measures to prevent variceal bleeding include the following:^[1]

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)

Prevention of liver disease

• Effective measures for the primary prevention of liver diseases, as the main causes of portal hypertension, include:^[2]
  • 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

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