Managing portal hypertension in patients with liver cirrhosis

Portal hypertension is one cause and a part of a dynamic process triggered by chronic liver disease, mostly induced by alcohol or incorrect nutrition and less often by viral infections and autoimmune or genetic disease. Adequate staging - continuously modified by current knowledge - should guide the...

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Bibliographic Details
Published in:F1000 research 2018, Vol.7, p.533
Main Authors: Sauerbruch, Tilman, Schierwagen, Robert, Trebicka, Jonel
Format: Article
Language:English
Subjects:
Alcohol
Antibiotics
Ascites
Bile
Blood flow
Cirrhosis
Disease prevention
Endoscopy
Esophagus
Etiology
Heart
Hepatic vein
Hepatitis
Hypertension
Immunosuppressive agents
Implants
Inflammation
Kidneys
Liver cancer
Liver cirrhosis
Liver diseases
Liver transplantation
Medical imaging
Metabolism
NMR
Nuclear magnetic resonance
Pathogenesis
Patients
Rodents
Shunts
Statins
Ultrasonic imaging
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Summary:Portal hypertension is one cause and a part of a dynamic process triggered by chronic liver disease, mostly induced by alcohol or incorrect nutrition and less often by viral infections and autoimmune or genetic disease. Adequate staging - continuously modified by current knowledge - should guide the prevention and treatment of portal hypertension with defined endpoints. The main goals are interruption of etiology and prevention of complications followed, if necessary, by treatment of these. For the past few decades, shunts, mostly as intrahepatic stent bypass between portal and hepatic vein branches, have played an important role in the prevention of recurrent bleeding and ascites formation, although their impact on survival remains ambiguous. Systemic drugs, such as non-selective beta-blockers, statins, or antibiotics, reduce portal hypertension by decreasing intrahepatic resistance or portal tributary blood flow or by blunting inflammatory stimuli inside and outside the liver. Here, the interactions among the gut, liver, and brain are increasingly examined for new therapeutic options. There is no general panacea. The interruption of initiating factors is key. If not possible or if not possible in a timely manner, combined approaches should receive more attention before considering liver transplantation.
ISSN:2046-1402
2046-1402
DOI:10.12688/f1000research.13943.1