Portal hypertension: from pathophysiology to clinical practice
- 11 November 2005
- journal article
- review article
- Published by Wiley in Liver International
- Vol. 25 (6), 1079-1090
- https://doi.org/10.1111/j.1478-3231.2005.01163.x
Abstract
Portal hypertension (PHT) is responsible for the more severe and often lethal complications of cirrhosis such as bleeding oesophageal varices, ascites, renal dysfunction and hepatic encephalopathy. Because of the combined impact of these complications, PHT remains the most important cause of morbidity and mortality in patients with cirrhosis. Over the years, it has become clear that a decrease in portal pressure is not only protective against the risk of variceal (re)bleeding but is also associated with a lower long-term risk of developing complications and an improved long-term survival. A milestone in therapy was the introduction of non-selective beta-blockers for the prevention of bleeding and rebleeding of gastro-esophageal varices. However, in practice, less than half the patients under beta-blockade are protected from these risks, supporting the overall demand for innovation and expansion of our therapeutic armamentarium. Recent advances in the knowledge of the pathophysiology of cirrhotic PHT have directed future therapy towards the increased intrahepatic vascular resistance, which, in part, is determined by an increased hepatic vascular tone. This increased vasculogenic component provides the rationale for the potential use of therapies aimed at increasing intrahepatic vasorelaxing capacity via gene therapy, liver-selective nitric oxide donors and statines on the one hand, and at antagonizing excessive intrahepatic vasoconstrictor force through the use of endothelin antagonists, angiotensin blockers, alpha(1) adrenergic antagonists or combined alpha(1)- and non-selective beta-blockers or somatostatin analogues on the other. The focus of this review is to give an update on the pathophysiology of PHT in order to elucidate these potential novel strategies subsequently.This publication has 71 references indexed in Scilit:
- Hepatic fibrogenesis requires sympathetic neurotransmittersGut, 2004
- Effect of losartan, an Angiotensin II receptor antagonist, on portal pressure in cirrhosisHepatology, 1999
- N-acetylcysteine prevents development of the hyperdynamic circulation in the portal hypertensive ratHepatology, 1998
- Increased endothelial nitric oxide synthase activity in the hyperemic vessels of portal hypertensive ratsJournal of Hepatology, 1996
- Endothelin antagonism in experimental hepatic fibrosis. Implications for endothelin in the pathogenesis of wound healing.JCI Insight, 1996
- Neonatal capsaicin treatment does not prevent splanchnic vasodilatation in portal-hypertensive ratsHepatology, 1994
- The Cellular Basis of Hepatic Fibrosis -- Mechanisms and Treatment StrategiesThe New England Journal of Medicine, 1993
- Role of bile acids in splanchnic hemodynamic response to chronic portal hypertensionDigestive Diseases and Sciences, 1991
- Propranolol in the Prevention of First Upper Gastrointestinal Tract Hemorrhage in Patients with Cirrhosis of the Liver and Esophageal VaricesThe New England Journal of Medicine, 1987
- Reduction of the increased portal vascular resistance of the isolated perfused cirrhotic rat liver by vasodilatorsJournal of Hepatology, 1985