Use of ß-blocker therapy to prevent primary bleeding of esophageal varices.

PURPOSE: The purpose of this article is to educate nurse practitioners about the pathophysiology surrounding the development of portal hypertension and the effective use of nonselective ß-blockers to prevent primary bleeding and decrease the mortality risk.

DATA SOURCES: The articles included were retrieved via ISI Web of Science using the years 2004-2009 and key words cirrhosis, portal hypertension, esophageal varices, and beta-blockers. This information included scholarly books, journal reviews, retrospective chart reviews, and prospective randomized studies.

CONCLUSIONS: Cirrhosis is the leading cause of portal hypertension in Europe and North America. Esophageal varices are a result of the portosystemic collaterals the body develops to decompress the portal system. Hemorrhage from esophageal varices is a major cause of morbidity and mortality. Prevention of a primary bleed is the goal of therapy and is accomplished with nonselective ß-blockers.

IMPLICATIONS FOR PRACTICE: Very few patients with portal hypertension and esophageal varices are on ß-blockers. Use of nonselective ß-blockers has been found to lower portal pressure and decreases the risk of bleeding from esophageal varices and therefore decreases mortality. Patients unable to use ß-blockers can undergo endoscopic variceal ligation as an alternate method to reduce risk of bleeding.