The management of portal hypertension: rational basis, available treatments and future options.
Variceal bleeding is the last step in a chain of events initiated by an increase in portal pressure, followed by the development and progressive dilation of varices until these finally rupture and bleed. This sequence of events might be prevented - and reversed - by achieving a sufficient decrease in portal pressure. A different approach is the use of local endoscopic treatments at the varices. This article reviews the rationale for the management of patients with cirrhosis and portal hypertension, the current recommendations for the prevention and treatment of variceal bleeding, and outlines the unsolved issues and the perspectives for the future opened by new research developments.
Bosch
Jaime
J
Hepatic Hemodynamic Laboratory, Liver Unit, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Hospital Clínic, C.Villarroel 170, 08036 Barcelona, Spain. jbosch@clinic.ub.es
Berzigotti
Annalisa
A
Garcia-Pagan
Juan Carlos
JC
Abraldes
Juan G
JG
D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology* / Q000628:therapy*; D008103:Liver Cirrhosis / Q000150:complications*; D016896:Treatment Outcome