Treatment of portal hypertension
Open Access
- 1 January 2012
- journal article
- review article
- Published by Baishideng Publishing Group Inc. in World Journal of Gastroenterology
- Vol. 18 (11), 1166-1175
- https://doi.org/10.3748/wjg.v18.i11.1166
Abstract
Portal hypertension is the main complication of cirrhosis and is defined as an hepatic venous pressure gradient (HVPG) of more than 5 mmHg. Clinically significant portal hypertension is defined as HVPG of 10 mmHg or more. Development of gastroesophageal varices and variceal hemorrhage are the most direct consequence of portal hypertension. Over the last decades significant advancements in the field have led to standard treatment options. These clinical recommendations have evolved mostly as a result of randomized controlled trials and consensus conferences among experts where existing evidence has been reviewed and future goals for research and practice guidelines have been proposed. Management of varices/variceal hemorrhage is based on the clinical stage of portal hypertension. No specific treatment has shown to prevent the formation of varices. Prevention of first variceal hemorrhage depends on the size/characteristics of varices. In patients with small varices and high risk of bleeding, non-selective β-blockers are recommended, while patients with medium/large varices can be treated with either β-blockers or esophageal band ligation. Standard of care for acute variceal hemorrhage consists of vasoactive drugs, endoscopic band ligation and antibiotics prophylaxis. Transjugular intrahepatic portosystemic shunt (TIPS) is reserved for those who fail standard of care or for patients who are likely to fail ("early TIPS"). Prevention of recurrent variceal hemorrhage consists of the combination of β-blockers and endoscopic band ligation.Keywords
This publication has 63 references indexed in Scilit:
- Clinical Pharmacology of Portal HypertensionGastroenterology Clinics of North America, 2010
- Management of Varices and Variceal Hemorrhage in CirrhosisThe New England Journal of Medicine, 2010
- Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleedJournal of Hepatology, 2009
- A pilot project examining the predicted preferences of patients and physicians in the primary prophylaxis of variceal hemorrhageJournal of Hepatology, 2007
- Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosisJournal of Hepatology, 2007
- A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleedingJournal of Hepatology, 2006
- Evolving Consensus in Portal Hypertension Report of the Baveno IV Consensus Workshop on methodology of diagnosis and therapy in portal hypertensionJournal of Hepatology, 2005
- Developing consensus in portal hypertensionJournal of Hepatology, 1996
- Definitions, methodology and therapeutic strategies in portal hypertension: A consensus development workshop, Baveno, Lake Maggiore, Italy, April 5 and 6, 1990Journal of Hepatology, 1992
- Prediction of the First Variceal Hemorrhage in Patients with Cirrhosis of the Liver and Esophageal VaricesThe New England Journal of Medicine, 1988