Diagnosis and treatment of clinically significant portal hypertension. Overview of the problem
DOI:
https://doi.org/10.11603/2414-4533.2020.4.11794Keywords:
diagnostics, treatment, liver cirrhosis, portal hypetensionAbstract
This report provides guidelines for patient management, modern methods of diagnosis and treatment of patients with clinically significant portal hypertension. The main emphasis in the work is on the problem of non-acute hemorrhagic complications. The material was developed at a consensus meeting of the Austrian Society of Gastroenterology and Hepatology (ÖGGH) and the Austrian Society of Interventional Radiology (ÖGIR), held on February 18, 2017, as well as on the basis of clinical and practical guideline for patients with decompensated cirrhosis from the European Association of Studies of Liver (EASL, 2018).
References
Jepsen, P., Ott, P., Andersen, P.K., Sorensen, H.T., & Vilstrup, H. (2010). Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology, 51,1675-1682.
Kovalak, M., Lake, J., Mattek, N., Eisen, G., Lieberman, D. & Zaman, A. (2007). Endoscopic screening for varices in cirrhotic patients: data from a national endoscopic database. Gastrointest. Endosc., 65, 82-88.
Merli, M., Nicolini, G., Angeloni, S., Rinaldi, V., De Santis, A., Merkel, C., et al. (2003). Incidence and natural history of small esophageal varices in cirrhotic patients. J. Hepatol., 38, 266-272.
Groszmann, R.J., Garcia-Tsao, G., Bosch, J., Grace, N.D., Burroughs, A.K., Planas, R., et al. (2005). Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N. Engl. J. Med., 353, 2254-2261.
D’Amico, G., Pasta, L., & Morabito, A., (2014). Competing risks and prognostic stages of cirrhosis: a 25-year inception cohort study of 494 patients. Aliment Pharmacol Ther, 39,1180–1193.
Bosch J., & Garcia-Pagan J.C. (2003). Prevention of variceal rebleeding. Lancet, 361, 952-954.
de Franchis, R., & Baveno, V.F. (2015) Expanding consensus in portal hypertension: Report of the Baveno VI consensus workshop: Stratifying risk and individualizing care for portal hypertension. J. Hepatol., 63,743-752.
Garcia-Tsao, G., Sanyal, A.J., Grace, N.D. , & Carey, W. (2007) Practice Guidelines Committee of the American Association for the Study of Liver DiseasesPractice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology, 46, 922-938.
Garcia-Pagan, J.-C., De Gottardi, A., & Bosch, J. (2008). Review article: the modern management of portal hypertension–primary and secondary prophylaxis of variceal bleeding in cirrhotic patients. Aliment. Pharmacol. Ther., 28, 178-186.
Hernandez-Gea, V., Aracil, C., Colomo, A., Garupera, I., Poca, M., Torras, X., et al. (2012). Development of ascites in compensated cirrhosis with severeportal hypertension treatedwith betablockers. Am. J. Gastroenterol.,107, 418-427.
Reiberger, T., Ulbrich, G., Ferlitsch, A., Payer, B.A., Schwabl, P., Pinter, M., et al. (2013). Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response topropranolol. Gut., 62, 1634-1641.
Villanueva, C., Graupera, I., Aracil, C., Alvarado, E., Minana, J., Puente, A., et al. (2017). A Randomized trial to assess whether portal pressure guided therapy to prevent variceal rebleeding improves survival in cirrhosis. Hepatology, 65 (5), 1693-1707.
Albillos, A., Banares, R., Gonzalez, M., Ripoll, C., Gonzalez, R., Catalina, M.V., et al. (2007). Value of the hepatic venous pressure gradient to monitor drug therapy for portal hypertension: a meta-analysis. Am, J, Gastroenterol., 102, 1116-1126.
Yoshikawa, I., Murata, I., Nakano, S., & Otsuki, M. (1998) Effects of endoscopic variceal ligation on portal hypertensive gastropathy and gastric mucosal blood flow. Am. J. Gastroenterol., 93,71-74.
North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study (1988). N. Engl. J. Med., 319, 983-989.
Urrunaga, N.H., & Rockey, D.C. (2014) Portal hypertensive gastropathy and colopathy. Clin. Liver Dis., 18, 389-406.
De Franchis R., Baveno VIF. (2015). Expanding consensus in portal hypertension: Report of the Baveno VI consensus workshop: Stratifying risk and individualizing care for portal hypertension. J. Hepatol. 63,743-752.
Rudler, M., Cluzel, P., Corvec, T.L., Benosman, H., Rousseau, G., Poynard, T., et al. (2014). Early-TIPSS placement prevents rebleeding in high-risk patients with variceal bleeding, without improving survival. Aliment Pharmacol Ther., 40, 1074-1080.
Puente, A., Hernandez-Gea, V., Graupera, I., Roque, M., Colomo, A., Poca, M., et al. (2014). Drugs plus ligation to prevent rebleeding in cirrhosis: an updated systematic review. Liver Int., 34,823-833.
La Mura, V., Nicolini, A., Tosetti, G., & Primignani, M. (2015). Cirrhosis and portal hypertension: The importance of risk stratification, the role of hepatic venous pressure gradientmeasurement. World J. Hepatol., 7, 688-695.
Mandorfer, M., & Reiberger, T. (2016). Beta-blocker sand cirrhosis. Dig. LiverDis., 2017, 49, 3-10.
Feu, F., Garcia-Pagan, J.C., Bosch, J., Luca, A., Teres, J., Escorsell, A., et al. (1995). Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhagein patientswithcirrhosis. Lancet., 346, 1056-5109.
La Mura, V., Abraldes, J.G., Raffa, S., Retto, O., Berzigotti, A., GarciaPagan, J.C., et al. (2009). Prognostic value of acute hemodynamic response to i. v. propranolol in patients with cirrhosis and portalhypertension. J. Hepatol., 51, 279-287.
Sauerbruch, T., Mengel, M., Dollinger, M., Zipprich, A., Rossle, M., Panther, E., et al. (2015). Prevention of Rebleeding from esophageal Varices in patients with cirrhosis receiving small-diameter stents versus hemodynamically controlled medical therapy. Gastroenterology, 149, 660-668.
Zipprich, A., Winkler, M., Seufferlein, T., & Dollinger, M.M. (2010). Comparison of balloon vs. straight catheter for the measurement of portal hypertension. Aliment Pharmacol. Ther., 32, 1351-1356.
Abraldes, J.G., Sarlieve, P., & Tandon, P. (2014). Measurement of portal pressure. Clin. Liver Dis., 18, 779-792.
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