Primary prophylaxis of variceal hemorrhage in children with portal hypertension: A framework for future research

Simon C. Ling, Thomas Walters, Patrick J. McKiernan, Kathleen B. Schwarz, Guadalupe Garcia-Tsao, Benjamin L. Shneider

Research output: Contribution to journalReview articlepeer-review

Abstract

Nonselective β-blocker therapy and endoscopic variceal ligation reduce the incidence of variceal hemorrhage in cirrhotic adults, but their use in children is controversial. There are no evidence-based recommendations for the prophylactic management of children at risk of variceal hemorrhage due to the lack of appropriate randomized controlled trials. In a recent gathering of experts at the American Association for the Study of Liver Diseases annual meeting, significant challenges were identified in attempting to design and implement a clinical trial of primary prophylaxis in children using either of these therapies. These challenges render such a trial unfeasible, primarily due to the large sample size required, inadequate knowledge of appropriate dosing of β-blockers, and difficulty in recruiting to a trial of endoscopic variceal ligation. Pediatric research should focus on addressing questions of natural history and diagnosis of varices, prediction of variceal bleeding, optimal approaches to β-blocker and ligation therapy, and alternative study designs to explore therapeutic efficacy in children.

Original languageEnglish (US)
Pages (from-to)254-261
Number of pages8
JournalJournal of pediatric gastroenterology and nutrition
Volume52
Issue number3
DOIs
StatePublished - Mar 2011

Keywords

  • endoscopic variceal ligation
  • esophageal varices
  • nonselective β-blockers
  • portal hypertension
  • primary prophylaxis
  • variceal bleeding

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

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