Gastro Medical News about variceal bleed

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Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed
Hepatology, 07/21/09

Hayes PC et al. – Carvedilol is effective in preventing the first variceal bleed. Carvedilol is an option for primary prophylaxis in patients with high–risk esophageal varices.

Exclusive Author Commentary
Peter C. Hayes, 07/28/09

This multi-centre trial, conducted in Scotland, compared the vasodilating beta-blocker carvedilol with endoscopic band ligation in the primary prevention of bleeding from oesophageal varices. It demonstrates that the two treatments are equivalent in terms of survival but carvedilol is more effective in reducing bleeding. Most clinical trials in portal hypertension were conducted in the 1980's and 90's with far fewer more recently. This is almost certainly related to how difficult and costly it is to set up clinical trials involving pharmaceutical agents currently. Most studies involved propranolol which is relatively poorly tolerated, reduces portal pressure sufficiently in only a proportion of patients and is taken twice daily. Carvedilol is taken once daily, appears to be well tolerated and reduces portal pressure more than propranolol. The result of this trial suggests that this drug is at least as good as banding and should be considered a first line option for the prevention of oesophageal variceal bleeding in patients at high risk of bleeding.

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