A commonsense approach to esophageal varices

Variceal hemorrhage is one of the most serious complications of portal hypertension and cirrhosis and is associated with a mortality of at least 20% at 6 weeks, despite improvements in therapy over the last decade. Variceal hemorrhage predisposes cirrhotic patients to worsening hepatic decompensation, infection, or renal insufficiency, which contribute to mortality. Providing primary prophylaxis against first variceal hemorrhage, general management of an acute bleeding episode, and treatment after variceal hemorrhage--mainly prevention of rebleeding--are equally important components of care for the cirrhotic patient who has gastroesophageal varices. This article describes a practical approach to the management of cirrhotic patients who have gastroesophageal varices.