Assessment and Management of Portal Hypertension

Abstract

Cirrhosis is the main cause of portal hypertension. Variceal bleeding is the most serious complication of portal hypertension. All cirrhotic patients should be screened endoscopically for varices which are present in about 50 % of patients at diagnosis. In patients without varices, endoscopy should be repeated every 2 years. Patients with high-risk varices (moderate or large in size, or with red color signs, or in Child-Pugh C patients) should be treated with a nonselective beta-blocker to prevent bleeding. Patients with contraindications to beta-blockers or who cannot tolerate these drugs should receive endoscopic band ligation. Acute variceal hemorrhage calls for intensive care and conservative blood transfusion policy. Treatment is based on the combined use of vasoactive drugs, endoscopic band ligation, and prophylactic antibiotics. Failures are best managed by transjugular intrahepatic portosystemic shunt. Patients surviving variceal bleeding are at high risk of rebleeding; medical therapies, using beta-blockers and endoscopic band ligation, are the recommended treatments.