Hi since no one has commented I thought to do a little research. Have you asked your doctor? I am thinking this would be for life kind of thing unless you have banding done
I found this at GI.org
E. Patients with Cirrhosis Who Have Recovered From Acute Variceal Hemorrhage
Patients who survive an episode of acute variceal hemorrhage have a very high risk of rebleeding and death. The median rebleeding rate in untreated individuals is around 60% within 1–2 years of the index hemorrhage, with a mortality of 33% (35, 36). It is therefore essential that patients who have recovered from an episode of variceal hemorrhage and have had no evidence of hemorrhage for at least 24 hours be started on therapy to prevent recurrence prior to discharge from the hospital. Patients who required shunt surgery/TIPS to control the acute episode do not require further preventive measures. All these patients should be referred to a transplant center if they are otherwise a candidate (i.e., Child-Pugh score ≥7or a MELD score ≥15).
Nonselective β-blockers or sclerotherapy reduce rates of variceal rebleeding to around 42–43% (35, 36, 82, 115), although patients treated with sclerotherapy have a higher rate of side effects. However, there are better pharmacological and endoscopic therapeutic options.
Regarding pharmacological therapy, the combination of a nonselective β-blocker and ISMN has a synergistic portal pressure-reducing effect and could theoretically be more effective than β-blockers alone. Only one study has performed a direct comparison between the combination of propranolol plus ISMN and propranolol alone in patients with prior variceal hemorrhage (116). This study showed a benefit of combination therapy (33% vs. 41% rebleeding rate), but it was not statistically significant. Data collected from different randomized clinical trials show that the median rebleeding rate in patients treated with combined pharmacological therapy is around 33–35% (35, 36), lower than that obtained with β-blockers alone. Therefore, the pharmacological therapy of choice in the prevention of variceal rebleeding is probably the combination of a nonselective β-blocker and a nitrate. However, this combination has significantly greater side effects compared to β-blockers alone (35, 116) and is poorly tolerated in clinical practice so that most patients end up taking β-blockers alone.
Regarding endoscopic therapy, EVL is the endoscopic method of choice for preventing variceal rebleeding since it has been shown to be superior to sclerotherapy (115, 117). Data collected from different randomized clinical trials show a median rebleeding rate in patients treated with EVL of around 32% (36). EVL sessions are repeated at 7- to 14-day intervals until variceal obliteration, which usually requires 2 to 4 sessions (118). Once eradicated, EGD is usually repeated every 3 to 6 months to evaluate for variceal recurrence and need for repeat EVL. Complications of EVL occur in about 14% of cases but are usually minor. The most common complication is transient dysphagia and chest discomfort. Shallow ulcers at the site of each ligation are the rule, and they may bleed. In a small (n = 43) randomized placebo-controlled trial of pantoprazole (40 mg IV after EVL followed by 40 mg oral every day for 9 days), the number of post-EVL ulcers at day 10 after EVL was the same in both groups; however, ulcers were significantly smaller in the pantoprazole group and, although not statistically significant, all 3 post-EVL bleeding episodes occurred in the placebo group (119). These results would favor the use of proton pump inhibitors in patients treated with EVL.
Optimal pharmacological therapy (β-blockers plus nitrates) versus optimal endoscopic therapy (EVL) has been compared in 3 randomized studies showing different results. One study showed a benefit of combination pharmacological therapy (23), another showed a benefit of EVL (120), and a third showed no difference between treatment groups, despite a clear tendency in favor of pharmacological therapy (121). These differences probably reflect the dosage of medications used, patient population and, ultimately, center expertise (122). Both therapies would appear to be at least equivalent in the prevention of variceal rebleeding with rebleeding rates of 32–35%.
Combination endoscopic plus pharmacological therapy is the most rational approach because nonselective β-blockers theoretically will protect against rebleeding prior to variceal obliteration and would prevent variceal recurrence. Two randomized trials demonstrate the superiority of combined therapy versus EVL alone (123, 124). Rebleeding rates in these 2 trials were 23% and 14%, respectively, for EVL plus nadolol compared to 47% and 38% for EVL alone. These results support the use of combination therapy to prevent rebleeding, even though a recent consensus conference recommended EVL or β-blocker + nitrates as first-line therapy in treatment naïve patients (7). The combination EVL plus a nonselective β-blocker is clearly recommended in patients who develop variceal hemorrhage (first or recurrent) while on EVL or a β-blocker alone.
The lowest rate of variceal rebleeding (~10%) is obtained in patients who are HVPG responders; that is, patients in whom pharmacological therapy (either β-blockers alone or β-blockers + nitrates) leads to a reduction in HVPG to 20% from baseline (19, 36). In patients who are HVPG responders, it would not be rational to use endoscopic therapy. As suggested recently, perhaps the most rational therapy would be to adapt the different therapies to prevent variceal rebleeding in the context of HVPG response (125, 126); however, this would require standardization of the HVPG technique, including the best timing to perform the repeat HVPG measurement. Existing studies have performed the second HVPG measurement a median of 90 days after the first measurement (range 19–159 days), and there is evidence suggesting that the predictive value of the change in HVPG is reduced with increasing time between measurements (19).
Copyright 1994-2018MedHelp.All rights reserved. MedHelp is a division of Vitals Consumer Services, LLC.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.