Medical treatment of portal hypertension

Roberto De Franchis, A. Dell'Era, F. Fabris, F. Iannuzzi, L. Fazzini, J. Cubero Sotela, R. Reati, M. Primignani

Research output: Contribution to journalArticle

Abstract

Prevention of the first variceal haemorrhage should start when the patients have developed medium sized to large varices. Non-selective beta-blockers are the first-line treatment; band ligation is roughly equivalent to beta-blockers and is the first choice for patients with contraindications or intolerance to beta-blockers. Treatment of acute bleeding should aim at controlling bleeding and preventing early rebleeding and complications, especially infections. Combined endoscopic and pharmacological treatment with vasoactive drugs can control bleeding in up to 90% of patients. All patients who survive a variceal bleed should be treated with beta-blockers or band ligation to prevent rebleeding. All patients in whom bleeding cannot be controlled or who continue to rebleed can be treated with salvage TIPS or, in selected cases, with surgical shunts. Liver transplantation should be considered for patients with severe liver insufficiency in which first-line treatments fail.

Original languageEnglish
Pages (from-to)334-343
Number of pages10
JournalActa Gastro-Enterologica Belgica
Volume67
Issue number4
Publication statusPublished - Oct 2004

Keywords

  • Beta blockers
  • Confidence intervals
  • Endoscopic sclerotherapy
  • Meta-analysis
  • Number needed to treat
  • Odds ratio
  • TIPS
  • Variceal bleeding; vasoactive drugs

ASJC Scopus subject areas

  • Gastroenterology

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  • Cite this

    De Franchis, R., Dell'Era, A., Fabris, F., Iannuzzi, F., Fazzini, L., Sotela, J. C., Reati, R., & Primignani, M. (2004). Medical treatment of portal hypertension. Acta Gastro-Enterologica Belgica, 67(4), 334-343.