The Management of Portal Hypertension
Section snippets
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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TIPS for management of portal-hypertension-related complications in patients with cirrhosis
2020, Clinics and Research in Hepatology and GastroenterologyCitation Excerpt :Balloon tamponade or, more recently, the esophageal stent, can be used as a bridge to TIPS in refractory variceal bleeding [33]. In case of acute variceal bleeding, some predictive factors of failure to control bleeding and mortality were identified as, for example, increased portal pressure and severity of underlying liver disease, suggesting that more effective therapy could be suitable for selected patients [34–43]. Monescillo et al. studied 52 patients considered at high risk of bleeding recurrence due to HVPG ≥ 20 mmHg.
Portal Hypertensive Bleeding
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