Elsevier

Clinics in Liver Disease

Volume 9, Issue 4, November 2005, Pages 685-713
Clinics in Liver Disease

The Management of Portal Hypertension

https://doi.org/10.1016/j.cld.2005.08.001Get rights and content

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Management of portal hypertension

Treatment of portal hypertension includes preventing variceal hemorrhage in patients who have never bled, treating the acute bleeding episode, and preventing rebleeding in patients who have survived a bleeding episode from esophageal or gastric varices. The main difference between these scenarios is that natural history and prognosis are very different in each. This knowledge of the natural history of each of these situations should guide the selection of therapies, since the hemostatic or

Gastric varices

Gastric varices develop in approximately 20% of patients with portal hypertension [136]. They are the source of 5% to 10% of all upper digestive bleeding episodes in patients with cirrhosis. The risk of gastric variceal bleeding is lower than of esophageal variceal bleeding, but gastric variceal bleeding, in particular that from fundal varices, tends to be more severe, to require more transfusions, and to have a higher mortality rate [136].

The optimal treatment of gastric varices has not been

Portal hypertensive gastropathy

Portal hypertensive gastropathy (PHG) is a macroscopic finding of a characteristic mosaic-like pattern of the gastric mucosa (mild PHG), red-point lesions, cherry red spots, or black-brown spots (severe PHG) [149]. These lesions, however, are not entirely specific (ie, can occur in the absence of portal hypertension). In PHG, there is marked dilatation of the vasculature of the gastric mucosa and submucosa, together with an increased blood flow and tendency towards decreased acid secretion. PHG

New drugs to treat portal hypertension

Nearly half of the patients treated with the combination of beta-adrenergic blockers and nitrates do not achieve the target reduction in portal pressure (greater than 20% from the baseline or to greater than 12 mmHg). Therefore, it is clear that there is room for improvement in the armamentarium to treat portal hypertension. Theoretically, the ideal drug to treat patients with cirrhosis and portal hypertension should act on the factor that initiates portal hypertension, decreasing the

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