Discussion on medical treatment of portal hypertension

The administration of beta-blockers in the early phase of cirrhosis does probably not prevent the formation of varices (1-3). Whether beta-blockers can prevent the growth from small to large varices remains to be deter- mined. At this moment two studies gave opposite results (1,4). Independent prognostic factors for first variceal bleeding are Child Pugh class, size of varices and red wale markings (5). All patients with medium or large- sized varices should receive primary prophylaxis. Beta-blockers are still the first choice for primary prophylaxis of oesophageal variceal bleeding. If the patients have contraindications or intolerance to beta- blockers, variceal band ligation can be an option for medium to large varices as primary prophylaxis. Isosorbide 5-mononitrate in monotherapy or in combi- nation with beta-blockers are not indicated for the pre- vention of first variceal bleeding.