Management of portal hypertension in children

Abstract

Portal hypertension can be caused by a wide variety of conditions. It frequently presents with bleeding from esophageal varices. The approach to acute variceal hemorrhage in children is a stepwise progression from least invasive to most invasive. Management of acute variceal bleeding is straightforward. But data on primary prophylaxis and long term management prevention of recurrent variceal bleeding in children is scarce, therefore prospective multicenter trials are needed to establish best practices.

Surviving Sengstaken

“…[4][5][6][7][8][9][10][11][12][13][14][15][16] year] were identified within the study period. Gastro-oesophageal varices (n = 18) and an aortooesophageal (AO) fistula were the causes for major bleeding.…”

“…Other sources of bleeding in PHT might include portal hypertensive gastropathy [15], gastric [16], duodenal [17] and ano-rectal varices [18]. Variceal bleeding in children is often triggered by an episode of upper respiratory tract infection, fever or aspirin ingestion [19].…”

Pediatric portal hypertension

“…Children with enlarged spleens are often first referred to a hematologist to rule out any possible hematologic processes, especially if leukopenia is present. Once hematologic causes are ruled out, referral to a pediatric gastroenterologist or hepatologist is appropriate 7. Clinical findings may include growth failure; one prospective study showed that 50% of children with EHPVO had growth retardation compared with healthy children who did not have EHPVO 5…”

Portal hypertension and its management in children

“…Normal pressure within the portal system ranges normally between 5 and 10 mm Hg 2. PHT is defined as portal venous pressure of >10 mm Hg.…”