What's new in portal hypertension?

Portal hypertension is defined as increased pressure in the portal venous system. The most common cause of portal hypertension is cirrhosis. In this setting, there is an increase in intrahepatic resistance leading to an increase in portal pressure. By increasing portal blood flow, splanchnic vasodil...

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Bibliographic Details
Published in:Liver international 2020-02, Vol.40 (S1), p.122-127
Main Authors: Mauro, Ezequiel, Gadano, Adrián
Format: Article
Language:English
Subjects:
Bile
Bleeding
Blood flow
Blood pressure
carvedilol
Cirrhosis
Diagnosis
Endoscopy
gastro‐esophageal varices
Hemorrhage
HVPG
Hypertension
Liver cirrhosis
liver stiffness
Medical prognosis
Octreotide
portal hypertension
propranolol
Somatostatin
Therapy
TIPS
variceal haemorrhage
Vasodilation
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Summary:Portal hypertension is defined as increased pressure in the portal venous system. The most common cause of portal hypertension is cirrhosis. In this setting, there is an increase in intrahepatic resistance leading to an increase in portal pressure. By increasing portal blood flow, splanchnic vasodilation further aggravates portal hypertension. New pathogenic pathways are being established which might result in new therapeutic strategies. The presence of varices at endoscopy and/or other abdominal portosystemic collaterals confirms the diagnosis of portal hypertension. The role of non‐invasive and imaging tests in the diagnosis and prognosis of portal hypertension has been clarified. Non‐selective beta‐blockers decrease both the risk of variceal haemorrhage and hepatic decompensation. Terlipressin, somatostatin or octreotide, in combination with early endoscopic therapy, are recommended for the treatment of acute variceal haemorrhage. Early Transjugular intrahepatic portosystemic shunt (TIPS) is effective as salvage therapy in acute variceal bleeding in selected patients and prevents rebleeding more effectively than endoscopic and medical therapy resulting in an increased survival.
ISSN:1478-3223
1478-3231
DOI:10.1111/liv.14366