Saturday, July 9, 2011

Prvention of Esophageal varices


Ideally, patients with known varices should receive treatment to reduce their risk of bleeding.

The non-selective β-blockers (e.g., propranolol 10 mg PO TID, timolol or nadolol 20 mg PO OD) and nitrates (e.g. isosorbide mononitrate (IMN) 20 mg BD to TID) have been evaluated for secondary prophylaxis. Non-selective β-blockers (but not cardioselective β-blockers like atenolol) are preferred because they decrease both cardiac output by β1 blockade and splanchnic blood flow by blocking vasodilating β2 receptors at splanchnic vasculature. The effectiveness of this treatment has been shown by a number of different studies.

Unfortunately, non-selective β-blockers do not prevent the formation of esophageal varices.

Ultimately the treatment of portal hypertension can prevent development of esophageal varices.

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