23rd July 2023

You are reviewing the results of an oesophago-gastro-duodenoscopy (OGD) performed for a patient on your ward

You are reviewing the results of an oesophago-gastro-duodenoscopy (OGD) performed for a patient on your ward. The patient has grade I varices with no evidence of bleeding. The patient had presented the week before with jaundice and confusion. An abdominal CT showed evidence of cirrhosis.

A non-invasive liver screen did not identify any cause of liver disease, and with a history of chronic, excess alcohol intake, the most likely diagnosis is ALD. You wish to start some medication as primary prophylaxis of variceal haemorrhage.

What medication would you start?

Select the SINGLE most appropriate option from the list below. Select ONE option only.