Prevention

In addition give beta-blockers ^a

Why?

• Beta-blockers reduce rebleeding and death (particularly from rebleeding) ^a
• However adverse effects (heart failure, asthma, bradycardia) are common ^a

Varices: beta-blockers reduce rebleeding and death, but cause side-effects

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
cirrhosis, oesophageal varices and first GI bleed a	beta-blockers	placebo or no treatment	free of rebleeding at 21 months	32%	2.38 (1.60 to 3.50)	5 (3 to 9)
			free of variceal rebleeding at 21 months	37%	2.3 (1.7 to 3.0)	5 (4 to 8)
			survival at 21 months	74%	1.4 (1.0 to 1.9)	17 (10 to infinity)
			no death from bleeding at 21 months	76%	1.65 (1.1 to 2.4)	13 (8 to 59)
			adverse effects at 21 months	91%	0.36 (0.23 to 0.56)	-8 (-17 to -5)
recent variceal bleed a	sclerotherapy and beta-blockers	sclerotherapy	rebleeding		0.66 (0.46 to 0.93)	10 (6 to 56)
			death		0.52 (0.28 to 0.95)	6 (4 to 78)