[Prevention of recurrent hemorrhage due to portal hypertension]

Gastrointestinal bleeding due to portal hypertension is a severe complication in patients with cirrhosis. Recurrent hemorrhage occurs in 75% of patients at 2 years, and medical treatment aims to induce a permanent decrease in portal pressure. A controlled study demonstrated that continuous administration of propranolol significantly decreased the risk of recurrent gastrointestinal bleeding in selected cirrhotic patients in good health. This efficacy was not found in unselected patients. The risk of recurrent gastrointestinal bleeding correlates with the development of hepatocellular carcinoma and poor compliance. Sclerotherapy of esophageal varices consists in obstruction of the varicosities. It has been demonstrated that esophageal sclerotherapy significantly reduces recurrent gastrointestinal bleeding, although a number of complications may occur.