Should children with esophageal varices receive beta-blockers for the primary prevention of variceal hemorrhage?

Esophageal variceal hemorrhage occurs in up to 10% of children with portal hypertension annually, and may be fatal. In contrast to the strong evidence in adults that nonselective beta-adrenergic antagonism reduces the risk of variceal bleeding by approximately 50%, few pediatric data are available. The use of beta-blockers for primary prophylaxis has been reported in children, but not tested in a randomized controlled trial. The risks and benefits in children remain unquantified and may differ from adults in light of the different cardiovascular response to hypovolemia in young children. The circumstances of the individual patient must, therefore, be carefully considered before beta-blockers are prescribed to children with esophageal varices.