Description

Variceal bleeding in a patient with cirrhosis is a sentinel
event. It heralds a marked decline in the survival
of the patient. The mortality associated with variceal
bleeding has declined over the past few decades due to
emerging pharmacological therapy such as terlipressin,
and endoscopic therapy such as endoscopic band ligation
(EBL). However, as the prognosis still remains guarded
after an initial bleed, clinicians need to be vigilant and
aggressive with both primary and secondary prevention
of variceal bleeding. Beta-blockers have emerged as the
mainstay of treatment for primary prevention and in most
cases of secondary prophylaxis. EBL may be used on
an individual basis for primary prevention where betablockers
are not well tolerated and may be used alone or
in conjunction with beta-blockers in secondary prevention.
As transplantation remains the only effective measure in
completely reversing portal hypertension, patients need
to be considered for transplantation as soon as there is
evidence of decompensation.