LEARNING OBJECTIVE

After this activity, the participant will be able to compare continuing non-selective beta blockers indefinitely versus stopping them after esophageal varices are eradicated during ligation program for secondary prophylaxis of esophageal variceal bleeding.

QUESTION 1

A 46-year-old man with a history of alcoholic cirrhosis presents to the emergency department with new-onset melena and hematemesis. On examination, he appears weak, but his mental status is stable with no signs of encephalopathy. His abdomen is soft, with no clinical ascites. Vitals include temperature 97.9, blood pressure 83/42 mm Hg, heart rate 112 bmp. Labs reveal hemoglobin 7.3 g/dL, hematocrit 18%, creatinine 1.3 mg/dL, total bilirubin 1.2 mg/dL, international normalized ratio 1.0, platelet count of 63 x 103/microL. You suspect that this is an esophageal variceal bleed and perform an upper endoscopy. The patient has esophageal varices with high-risk stigmata and you perform esophageal band ligation. What additional medication would you prescribe to the patient on discharge?

Propranolol Rifaximin Ceftriaxone Metoprolol QUESTION 2

According to this study, which of the following patients would benefit from being on a non-selective beta blocker following endoscopic variceal band ligation for bleeding esophageal varices?

A patient with hepatocellular carcinoma A patient with refractory ascites A patient with compensated cirrhosis A patient with grade 3 hepatic encephaolopathy QUESTION 3

When compared to patients who stopped non-selective beta blockers after eradication of esophageal varices (Group A), patients who were continued on non-selective beta blockers (Group B):

Had an increased survival benefit Had more adverse events requiring diagnostic or therapeutic intervention Had a significant decrease in recurrent esophageal variceal bleeding Had a lower incidence of further decompensation