VARICEAL BLEEDING - CAN IT BE PREVENTED

Esophageal and gastric varices develop as a consequence of portal hype rtension and advanced chronic liver disease, Bleeding from these varic es causes high mortality and morbidity, The exact mechanism leading to rupture of varices is unknown, but portal pressure, intravariceal pre ssure, and increased variceal wall tension may be factors, Large varic es are most likely to bleed, and some studies suggest that red wales o n varices may predict bleeding risk. Surgery and endoscopic sclerother apy are not useful for preventing initial variceal bleeding, but nonse lective beta-adrenergic blocking drugs have been shown to be beneficia l in primary prophylaxis. Proper selection of patients and careful mon itoring of side effects during treatment enhance successful outcomes.