ABSTRACT
Continuing advances in the knowledge of the pathophysiology of portal hypertension
result in the progressive expansion of the spectrum of drugs with a potential role
for clinical practice, with objectives that now tend to include the prevention of
the enlargement or even the development of esophageal varices. This systematic review
summarizes the evidence of efficacy of drug therapy for portal hypertension and draws
recommendations for clinical practice. Although there is not yet enough evidence to
support the treatment for the prevention of the development or enlargement of varices,
nonselective beta-blockers are the first-choice therapy to prevent the first bleeding
in patients with medium or large-sized varices and rebleeding in patients surviving
a bleeding episode. The clinical role of isosorbide-5-mononitrate either alone or
in association with beta-blockers still remains unsettled. Vasoactive drugs are generally
effective and safe in controlling acute variceal bleeding, although the evidence is
not equivalent for each of them.
KEY WORDS
portal hypertension - variceal bleeding - drug therapy