Evolution in the understanding of the pathophysiological basis of portal hypertension: How changes in paradigm are leading to successful new treatments.
Among the common complication of cirrhosis portal hypertension witnessed a major improvement of prognosis during the past decades. Principally due to the introduction of rational treatments based on new pathophysiological paradigms (concepts of thought) developed in the 1980s. The best example being the use of non-selective beta-blockers and of vasopressin analogs, somatostatin, and its analogs. Further refinement in the knowledge of the molecular mechanisms involved in the regulation of both the splanchnic and hepatic circulation has led to the emergence of new treatments, which are based on evidence that show not only structural but also vasoactive components increase the hepatic vascular resistance, as well as of angiogenesis. This knowledge and future improvements will most likely result in more effective treatment of portal hypertension and effective prevention of its complications in early stages.
Hospital Clínic-IDIBAPS, University of Barcelona and Centro de Investigación, Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain. Electronic address: jbosch@clinic.ub.es.
Jaume
J
Bosch
Yale University, School of Medicine New Haven, CT, USA.
Roberto J
RJ
Groszmann
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Vijay H
VH
Shah
D006499:Hepatic Artery / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy / Q000503:physiopathology*; D008102:Liver Circulation; D018919:Neovascularization, Physiologic; D013152:Splanchnic Circulation
Endothelial dysfunction; Hepatic stellate cells; Hyperdynamic syndrome; Liver sinusoidal endothelial cells; Portal pressure; Splanchnic vasodilation