Mersdessa, Guda(consultant internist,Gastro Interologist and Hepatologist)Jemal, Kamil2021-02-072023-11-052021-02-072023-11-052020-12http://etd.aau.edu.et/handle/123456789/25014Background: - Variceal bleeding refers to bleeding due to rupture of varix which is usually found in the esophagus or stomach. Recurrent variceal bleeding is a bleeding episode that occurs after 5 th day of initial episode. The approaches to patients who have had first variceal bleeding is controlling the acute bleeding and prevent further re-bleeding. To prevent re-bleeding and mortality, secondary prophylaxis is indicated for all patients. This usually requires repeated variceal band ligation until varices are obliterated and/or nonselective Beta blocker. Failure to apply guideline based clinical practice of secondary prophylaxis will predispose to increased risk of recurrent variceal bleeding, hospitalization and mortality. There is no published data regarding clinical practice of secondary prophylaxis for variceal bleeding and prevalence of recurrence in Ethiopian context. Objective: - To assess the clinical practice of secondary prophylaxis for variceal bleeding and prevalence of recurrence among adult patients in Tikur Anbesa Specialized Hospital, in Addis Ababa, Ethiopia, 2015-2019. Methods: - A hospital based cross-sectional study was conducted on 140 adults who had endoscopically confirmed variceal bleeding during 2015-2019. Retrospective data from hospital records including socio-demographic characteristics, clinical and laboratory data and endoscopic results of the patients were collected. EpiData version 4.4.2.1 software was used for data entry and STATA15.1 for analysis. Descriptive data were presented as mean, percentage and standard deviations. Result: - Propranolol was the main medical treatment given as secondary prophylaxis. Propranolol (96.4%), EVL & propranolol (2.9%), and carvidelol (0.7%) were started before or at discharge. Of these patients 9.4%, 11.5%, 20.2% and 28.6% achieved the guide line recommended target heart rate at 2-6 week, 6 week-3 month, 3 month-6 month, and 6 month- 1 year respectively on follow up. More than 70% of the pat ients’ heart rate is not in the target rate in each follow up. 61.2%, 65.8%, 53.6%, 69% patients had their dose of propranolol adjusted at each consecutive follow up. Significant proportion of patients, 38.8%, 34.2%, 46.4%, & 31% were not provided with the appropriate dose adjustment. Of the patients who were on follow up 11.5% had experienced recurrence of variceal bleeding. Conclusion and recommendation:-There was a significant gap in clinical practice of guideline recommended secondary prophylaxis for the prevention of variceal rebleeding in patients on follow up in TASH during the study period. There was lack of continuous supply of EVL bands in the country and appropriate escalation of the dose of propranolol was not implemented as per guideline recommendations in significant proportion of patient. Physicians should follow the appropriate evidence based guidelines in the management of variceal bleeding and prevention of rebleeding. Furthermore the hospital should avail necessary supplies like EVL which are vital for endoscopic intervention to control acute bleeding and for prevention of rebleeding.en-USProphylaxis, varceal bleeding , adult patientsThesis