Prophylaxis of first variceal bleeding

Almost all patients with chronic liver disease will develop portal hypertension. The main clinical compli- cations of portal hypertension are ascites formation and its sequelae, porta systemic shunting with hepatic encephalopathy and gastro-oesophageal varices forma- tion with bleeding. Variceal bleeding accounts for 10 to 30% of all cases of upper gastro-intestinal haemorrhage (1). Variceal bleeding occurs in 25 to 35% of patients with cirrhosis and accounts for 75 to 90% of bleeding episodes in these patients (2,3). The mortality rate of first variceal haemorrhage remains high (20- 35%) in spite of significant improvements in treatment and is associated with a high hospital cost (4,5). Therefore prevention of bleeding is still the way to go.