Carvedilol delays the progression of small oesophageal varices in patients with cirrhosis: an unmet need finally met?

Non-selective beta blocker (NSBB) therapy remains the front runner in the treatment of portal hypertension. Over the years, our understanding of their mechanisms of action, both haemodynamic and non-haemodynamic, has evolved. Variceal bleeding, an inevitable consequence of portal hypertension, accounts for 10% of all admissions with gastrointestinal bleeding, and has an inpatient mortality of 15% and 1 year mortality of up to 40% (1). Reducing the risk of the development of varices (pre-primary prophylaxis) and the first variceal bleed (primary prevention) are therefore important clinical goals.