What to Do about Esophageal Varices?

In this issue of the Journal , Burroughs and colleagues report the results of a two-year randomized controlled trial of propranolol therapy to prevent recurrent bleeding from esophageal varices. 1 There was no reduction in the frequency of bleeding from either varices or mucosal erosions despite a substantial reduction in wedged hepatic-vein pressure. These results are disappointing, to say the least. Compliance by the patients taking propranolol was good, judging from decreases in pulse rate, though it seems possible that the alcoholic patients who had resumed drinking were not taking their medication at the time of the bleeding episodes. Forty-eight patients . . .