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World J Gastroenterol. Mar 21, 2012; 18(11): 1166-1175
Published online Mar 21, 2012. doi: 10.3748/wjg.v18.i11.1166
Treatment of portal hypertension
Khurram Bari, Guadalupe Garcia-Tsao
Khurram Bari, Guadalupe Garcia-Tsao, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT and VA-Connecticut Healthcare System, West Haven, CT 06520, United States
Author contributions: Bari K performed the literature review and wrote the article; Garcia-Tsao G was responsible for reviewing and revising the article for important intellectual content; Garcia-Tsao G was responsible for final approval for publication.
Correspondence to: Guadalupe Garcia-Tsao, MD, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT and VA-Connecticut Healthcare System, West Haven, CT 06520, United States. guadalupe.garcia-tsao@yale.edu
Telephone: +1-203-7376063 Fax: +1-203-7857273
Received: July 2, 2011
Revised: November 15, 2011
Accepted: December 31, 2011
Published online: March 21, 2012
Abstract

Portal hypertension is the main complication of cirrhosis and is defined as an hepatic venous pressure gradient (HVPG) of more than 5 mmHg. Clinically significant portal hypertension is defined as HVPG of 10 mmHg or more. Development of gastroesophageal varices and variceal hemorrhage are the most direct consequence of portal hypertension. Over the last decades significant advancements in the field have led to standard treatment options. These clinical recommendations have evolved mostly as a result of randomized controlled trials and consensus conferences among experts where existing evidence has been reviewed and future goals for research and practice guidelines have been proposed. Management of varices/variceal hemorrhage is based on the clinical stage of portal hypertension. No specific treatment has shown to prevent the formation of varices. Prevention of first variceal hemorrhage depends on the size/characteristics of varices. In patients with small varices and high risk of bleeding, non-selective β-blockers are recommended, while patients with medium/large varices can be treated with either β-blockers or esophageal band ligation. Standard of care for acute variceal hemorrhage consists of vasoactive drugs, endoscopic band ligation and antibiotics prophylaxis. Transjugular intrahepatic portosystemic shunt (TIPS) is reserved for those who fail standard of care or for patients who are likely to fail (“early TIPS”). Prevention of recurrent variceal hemorrhage consists of the combination of β-blockers and endoscopic band ligation.

Keywords: Cirrhosis; Portal hypertension; Varices; Variceal hemorrhage; Primary prophylaxis; Secondary prophylaxis