Cirrhotic portal hypertension: current and future medical therapy for primary and secondary prevention of variceal bleeding.
Portal hypertension (PHT) is the most common complication of chronic liver disease and develops in the vast majority of patients with cirrhosis. It is characterized by an increase of the portal vein pressure, and leads to the development of gastroesophageal varices, ascites, renal dysfunction and hepatic encephalopathy. Over the years, it has become clear that a decrease in portal pressure is not only protective against the risk of variceal (re)bleeding but is also associated with a lower long-term risk of developing other complications and with an improved long-term survival. At present, non-selective b-blockers remain the medical treatment of choice for both primary and secondary prophylaxis. However, recent advances in the knowledge of the pathophysiology of cirrhotic PHT have directed future therapy towards the increased intrahepatic vascular resistance, which in part is determined by an increased hepatic vascular tone. This increased vasculogenic component provides the motivation to the use of therapies aimed at increasing intrahepatic vasorelaxing capacity on the one hand and at antagonizing excessive intrahepatic vasoconstrictor force on the other hand. This review covers current and future developments in the treatment of PHT with regard to primary and secondary prophylaxis.
Laleman
W
W
Department of Hepatology, University Hospital Gasthuisberg, K.U. Leuven, B-3000 Leuven, Belgium.
Nevens
F
F
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D000818:Animals; D000075202:Contraindications; D004359:Drug Therapy, Combination; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D005544:Forecasting; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery; D007548:Isosorbide Dinitrate / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D008875:Middle Aged; D009248:Nadolol / Q000008:administration & dosage / Q000627:therapeutic use; D011170:Portasystemic Shunt, Surgical; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D017410:Practice Guidelines as Topic; D011433:Propranolol / Q000008:administration & dosage / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D051381:Rats; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013152:Splanchnic Circulation; D015607:Stents; D013997:Time Factors; D014655:Vascular Resistance; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D014665:Vasodilator Agents; D009248:Nadolol; D011433:Propranolol; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate