All patients with liver cirrhosis and portal hypertension should be stratified by risk groups to individualize different therapeutic strategies to increase the effectiveness of treatment. In this regard, the development of primary prophylaxis of variceal bleeding and its management according to the severity of portal hypertension may be promising. This paper is to describe the modern principles of primary prophylaxis of esophageal variceal bleeding in patients with liver cirrhosis. The PubMed and EMbase databases, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews were used to search for relevant publications from 1999 to 2019. The results suggested that depending on the severity of portal hypertension, patients with cirrhosis should be divided into those who need preprimary prophylaxis, which aims to prevent the formation of esophageal varices, and those who require measures that aim to prevent esophageal variceal bleeding. In subclinical portal hypertension, therapy should be etiological and pathogenetic. Cirrhosis with clinically significant portal hypertension should receive nonselective β‐blockers if they have small esophageal varices and risk factors for variceal bleeding. Nonselective β‐blockers are the first‐line drugs for the primary prevention of bleeding from medium to large‐sized esophageal varices. Endoscopic band ligation is indicated for the patients who are intolerant to nonselective β‐blockers or in the case of contraindications to pharmacological therapy. In summary, the stratification of cirrhotic patients by the severity of portal hypertension and an individual approach to the choice of treatment may increase the effectiveness of therapy as well as improve survival rate of these patients.

中文翻译：

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肝硬化患者食管静脉曲张出血的一级预防：文献更新与复习

所有肝硬化门脉高压患者均应按危险人群分层，制定个体化不同治疗策略，以提高治疗效果。在这方面，根据门静脉高压症的严重程度开发静脉曲张出血的一级预防和管理可能是有希望的。本文旨在描述肝硬化患者食管静脉曲张静脉出血一级预防的现代原则。使用PubMed和EMbase数据库、Web of Science、Google Scholar和Cochrane Database of Systematic Reviews检索1999-2019年的相关文献。那些需要初步预防的人，旨在预防食管静脉曲张形成的人群，以及需要采取措施预防食管静脉曲张出血的人群。在亚临床门静脉高压症中，治疗应该是病因学和病理学的。具有临床显着性门静脉高压症的肝硬化，如果有小的食管静脉曲张和静脉曲张出血的危险因素，应接受非选择性 β 受体阻滞剂。非选择性β受体阻滞剂是大中型食管静脉曲张出血一级预防的一线药物。对非选择性 β 受体阻滞剂不耐受或有药物治疗禁忌症的患者，可进行内镜套扎术。总之，