scholarly journals Should Children with Esophageal Varices Receive Beta-Blockers for the Primary Prevention of Variceal Hemorrhage?

2005 ◽  
Vol 19 (11) ◽  
pp. 661-666 ◽  
Author(s):  
Simon C Ling
Keyword(s):  
Esophageal Varices ◽  
Cardiovascular Response ◽  
Beta Blockers ◽  
Controlled Trial ◽  
Primary Prophylaxis ◽  
Variceal Hemorrhage ◽  
Esophageal Variceal ◽  
Randomized Controlled ◽  
Risks And Benefits ◽  
The Individual

Esophageal variceal hemorrhage occurs in up to 10% of children with portal hypertension annually, and may be fatal. In contrast to the strong evidence in adults that nonselective beta-adrenergic antagonism reduces the risk of variceal bleeding by approximately 50%, few pediatric data are available. The use of beta-blockers for primary prophylaxis has been reported in children, but not tested in a randomized controlled trial. The risks and benefits in children remain unquantified and may differ from adults in light of the different cardiovascular response to hypovolemia in young children. The circumstances of the individual patient must, therefore, be carefully considered before beta-blockers are prescribed to children with esophageal varices.

scholarly journals Motion – Prophylactic Banding of Esophageal Varices Is Useful: Arguments against the Motion

2002 ◽  
Vol 16 (10) ◽  
pp. 693-695 ◽  
Author(s):  
Kris V Kowdley
Keyword(s):  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Beta Blockers ◽  
Low Cost ◽  
Cost Effective ◽  
Primary Prophylaxis ◽  
Ease Of Use ◽  
Endoscopic Sclerotherapy ◽  
Variceal Hemorrhage ◽  
Band Ligation

Bleeding from esophageal varices leads to substantial morbidity and mortality. Despite advances in pharmacological and endoscopic therapy, as well as general supportive care, the mortality rate associated with acute variceal hemorrhage has not improved significantly over the past two decades. Prophylactic therapy with nonselective beta-blockers or long acting nitrates reduces the incidence of variceal bleeding in patients with cirrhosis, is cost effective and may improve survival. Surgical portosystemic shunting reduces the risk of bleeding but is associated with significant operative mortality and a high risk of portosystemic encephalopathy. Endoscopic sclerotherapy causes adverse effects in a large proportion of patients and is, therefore, not suitable for primary prophylaxis of bleeding. Although variceal band ligation is effective in reducing the rate of bleeding and is safer than sclerotherapy, it has not been shown to provide a survival advantage compared with beta-blockers. A significant reduction in the rate of variceal bleeding with band ligation, compared with beta-blockers, was shown in only one study. Beta-blockers offer several advantages, including low cost, ease of use and safety. The available data do not yet support the prophylactic use of variceal band ligation, and this procedure should be reserved for patients who are either unwilling or unable to take beta-blockers. It is hoped that additional large, multicentre trials of band ligation versus beta-blockers will examine the efficacy, cost effectiveness and impact on quality of life among patients with cirrhosis.

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