A patient with suspected esophageal variceal bleeding should receive which initial therapy?

• A. Urget endoscopy
• B. Volume resuscitation and consideration of octreotide, with urgent endoscopy
• C. Proton pump inhibitors
• D. Antibiotics alone

Answer: (B)

The main idea is to stabilize the patient and reduce ongoing portal hypertension before definitive treatment. In suspected esophageal variceal bleeding, start with aggressive but careful volume resuscitation to maintain perfusion while avoiding overtransfusion that can raise portal pressures. Initiate a vasoactive agent such as octreotide to decrease splanchnic blood flow and lower portal pressure, which helps control and limit bleeding. Plan for urgent endoscopy to directly visualize and treat the varices, typically with band ligation, within a short time frame. Antibiotic prophylaxis is also recommended in this scenario to prevent infections that worsen outcomes, even though the immediate focus is on stabilization, vasoactive therapy, and prompt endoscopic control of the bleed.