Portal hypertension.
OBJECTIVE
Significant advances in the pathophysiology, diagnosis and management of the complications of portal hypertension that have occurred in the last year are reported.


RESULTS
The specific areas reviewed are those that refer to experimental studies aimed at modifying the factors that lead to portal hypertension (increased intrahepatic vascular resistance and splanchnic vasodilatation) and recent advances in the diagnosis and management of the complications of portal hypertension. The specific complications reviewed in this paper are varices and variceal bleeding (primary prophylaxis, treatment of the acute episode and secondary prophylaxis), ascites and hepatorenal syndrome, spontaneous bacterial peritonitis and hepatic encephalopathy, as well as recent studies of predictors of death in cirrhosis.


CONCLUSIONS
Important studies, mostly prospective, regarding the management of the complications of portal hypertension are reviewed, including a trial of beta-blockers in the prevention of varices, a randomized trial of endoscopic variceal ligation plus nadolol in preventing recurrent variceal bleeding and several meta-analyses on trials comparing large-volume paracentesis with transjugular intrahepatic portosystemic shunt in the management of refractory ascites.
Section of Digestive Diseases, Yale University School of Medicine and Connecticut VA, Healthcare System, New Haven, 06510, USA. guadalupe.garcia-tsao@yale.edu
Guadalupe
G
Garcia-Tsao
D000818:Animals; D001201:Ascites / Q000209:etiology / Q000628:therapy; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000628:therapy; D006530:Hepatorenal Syndrome / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D010538:Peritonitis / Q000209:etiology / Q000628:therapy