Management of portal hypertension

Abstract

Treatment of portal hypertension is evolving based on randomised controlled trials. In acute variceal bleeding, prophylactic antibiotics are mandatory, reducing mortality as well as preventing infections. Terlipressin or somatostatin combined with endoscopic ligation or sclerotherapy is the best strategy for control of bleeding but there is no added effect of vasoactive drugs on mortality. Non-selective β-blockers are the first choice therapy for both secondary and primary prevention; if contraindications or intolerance to β-blockers are present then band ligation should be used. Novel therapies target the increased intrahepatic resistance caused by microcirculatory intrahepatic deficiency of nitric oxide and contraction of activated intrahepatic stellate cells.

Relationship between angiotensin-(1-7) and angiotensin II correlates with hemodynamic changes in human liver cirrhosis

“…Other studies have also detected increased PRA and Ang Ⅱ levels in ALD patients [8,18] . In the initial stages of human cirrhosis, PRA measurements revealed a non-activated or even suppressed circulating RAS [16,18] . In this regard, we have recently found that chronic treatment with propranolol in advanced cirrhotic patients is characterized by marked changes in the precursors of the RAS cascade (renin and Ang Ⅰ) with repercussions in the 2 main components of the RAS [Ang Ⅱ and Ang-(1-7)] in the splanchnic and peripheral circulation [15] .…”

“…Table 1 displays the Child-Pugh scores [16] of our patients. The primary etiology of the liver disease was established in 21 subjects (87.5%), and included alcoholism, hepatitis C virus, hepatitis B virus and biliary cirrhosis.…”

“…All cirrhotic patients showed portal hypertension at the time criteria were set for each protocol group. Cirrhotic patients were then allocated to one of 3 study groups based on the presence or absence of ascites and values of Child-Pugh score [16] : the first group was composed of patients who had mild-to-moderate liver disease (MLD, n = 8), the second group included patients with advanced liver disease (ALD, n = 7), which were seen in an outpatient clinic and the third group was composed of liver transplant recipients during surgery (LT, n = 9).…”

Management of Portal Hypertension in Paediatric Age Group

“…(2) The strangulated varix, subsequently thromboses and sloughs. Usually up to three bands are applied at each session.…”

Pathophysiologic basis for the medical management of portal hypertension

“…The incidence of variceal bleeding is ∼ 30% in patients with compensated cirrhosis and 60% in those with decompensated cirrhosis [26] . Mortality associated with acute variceal bleeding ranges from 5 to 35% depending on patient age and disease severity [27] . Factors predictive of the risk of bleeding include the severity of liver disease as indicated by the Child-Pugh grade, increased variceal size and the presence of red wale markings on the varices [28] .…”