Gastrointestinal varices primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]


Primary prevention of variceal bleeding may be achieved via rigorous surveillance of varices after their development and via the use non-selective beta blockers and/or endoscopic band ligation (EBL). Liver disease is the most common cause of portal hypertension and effective measures for the primary prevention of liver diseases include hepatitis B vaccination, avoidance from unprotected sexual intercourse, precise screening of the blood products before infusion, reducing alcohol consumption, obesity prevention, and diabetes mellitus prevention.

Primary Prevention

Effective measures to prevent variceal bleeding include the following:[1]


  • Diagnostic endoscopy for the presence of varices

No varices

  • Surveillance for development of varices (every 2-3 yr in compensated cirrhosis/yearly in cases of decompensation)

Small varices-low bleeding risk

  • Surveillance for progression of varices (every 1-2 yr in compensated cirrhosis/yearly in cases of decompensation)

Small varices-high bleeding risk

Medium-large varices

Prevention of liver disease


  1. Triantos C, Kalafateli M (2014). "Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis". World J Hepatol. 6 (6): 363–9. doi:10.4254/wjh.v6.i6.363. PMC 4081611. PMID 25018847.
  2. Flores YN, Lang CM, Salmerón J, Bastani R (2012). "Risk factors for liver disease and associated knowledge and practices among Mexican adults in the US and Mexico". J Community Health. 37 (2): 403–11. doi:10.1007/s10900-011-9457-4. PMID 21877109.

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