Primary prevention

Preventing portal hypertension necessitates addressing the underlying cause of liver disease, such as weight reduction and avoidance of excessive alcohol use.

Hepatitis B vaccination, and the wider availability of direct antiviral agents for hepatitis C and chronic hepatitis B, will reduce disease burden and subsequent cirrhosis.[25][28]

Secondary prevention

Patients with acute variceal hemorrhage are at high risk of rebleeding.

Once stabilized, patients should be treated with nonselective beta-blockers to reduce variceal rebleeding unless shunt therapy has been performed. Clinical and hemodynamic studies indicate that carvedilol (which is both a nonselective beta-blocker and an alpha-1 adrenergic receptor blocker) may be an effective alternative to nonselective beta-blockers.[69] Repeat endoscopic therapy should be performed every 2-3 weeks until varices are completely eradicated. Endoscopic surveillance schedule after variceal eradication by banding ligation is 3 months, then after 6 months, and then yearly.[37]​ Combination medical therapy and endoscopic ligation is currently considered the best option to prevent rebleeding.[5][37]​​[38]

In patients who have episodes of rebleeding despite combination therapy, a transjugular intrahepatic porto-systemic shunt (TIPS) should be considered.[5][38][56]​​ A distal splenorenal surgical shunt is an alternative to TIPS in patients with nonemergent bleeding who have compensated liver disease.[70]​​ [ Cochrane Clinical Answers logo ]

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