الفهرس 
Introduction and aim of work
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Abstract
background : ruptured oesophageal varices is the most common cause of upper gastrointestinal bleeding in egypt with major morbidity and mortality, especially in cirrhotic patients. . endoscopic, pharmacological and radiological treatments are effective in preventing recurrent variceal bleeding. carvedilol combines a nonselective beta¬blocker action with an alpha¬1¬adrenoceptor blocking activity, thus mimicking the effects of the combination therapy of propranolol/nadolol plus prazosin, which causes a very pronounced decrease in portal pressure, but is associated with hypotension. aim of work : to assess the efficacy and safety of long¬term carvedilol treatment for prevention of variceal rebleeding in cirrhotic patients when added to endoscopic sclerotherapy comparing with either sclerotherapy alone and sclerotherapy plus propranolol . methods : our study was carried out on 90 patients presented with the first attack variceal bleeding at the mansoura emergency hospital. . they are classified into three groups . group i (patient received carvedilol 12. 5 mg/d) includes 30 patients with the mean age 49. 8±3. 65 years, three of them are female while 27 patients are males. group ii (patient received propranolol 40 mg/d) includes 30 patients with the mean age 48. 8±4. 53 years , one of them is female while 29 patients are males. group iii (control ) includes 30 patients with the mean age 48 ±2. 8 years , five of them are female while 25patients are males. all patients were subjected full clinical evaluation , laboratory evaluation and repeated upper git endoscopy every two weeks for 12 weeks. results : there was statistically significant difference between groups, as regard the effect of both propranolol and carvedilol on oesophageal varices on comparison with sclerotherapy alone . there was statistically significant difference between groups, as regard the effect of both propranolol and carvedilol on the rate of re¬bleeding and number of re¬bleeding episodes. there was statistically significant difference between groups, as regard pulse and map . both propranolol and carvedilol significantly decrease the pulse rate but the effect of the propranolol is more . we found that there was no significant side effects for carvedilol and in spite its hypotensive effect all patients included in the study tolerate it and do not stop therapy. conclusion : we conclude that carvedilol at low dose (12. 5mg/d) seems to be a viable option in prevention of re¬bleeding in patients with esophageal varices when compared with propranolol(40mg/d) on the period of our study (12 w) , with little hemodynamic changes