A 50-year-old man with cirrhosis undergoes screening endoscopy and is found to have medium-sized esophageal varices without red signs and no history of variceal bleeding. Which is the recommended primary prophylaxis?
- A Endoscopic variceal ligation alone
- B Octreotide infusion
- C Non-selective beta blocker (propranolol or nadolol) ✓
- D Transjugular intrahepatic portosystemic shunt (TIPS)
Correct answer: C. Non-selective beta blocker (propranolol or nadolol)
Explanation
Non-selective beta blockers (propranolol, nadolol, or carvedilol) are first-line for primary prophylaxis of medium or large esophageal varices. They reduce portal pressure by splanchnic vasoconstriction. Endoscopic variceal ligation is an alternative for medium or large varices if beta blockers are contraindicated or not tolerated. Octreotide is used for acute variceal bleeding. TIPS is reserved for refractory acute bleeding or recurrent bleeding despite endoscopic and pharmacologic therapy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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