Commentary - (2025) Volume 9, Issue 2
Received: 01-Mar-2025, Manuscript No. hps-25-172149;
Editor assigned: 03-Mar-2025, Pre QC No. P-172149;
Reviewed: 17-Mar-2025, QC No. Q-172149;
Revised: 22-Mar-2025, Manuscript No. R-172149;
Published:
29-Mar-2025
, DOI: 10.37421/2573-4563.2024.9.330
Citation: Kuznetsova, Natasha. ”Portal Hypertension: Modern Diagnosis, Treatment and Guidelines.” J Hepatol Pancreat Sci 09 (2025):330.
Copyright: © 2025 Kuznetsova N. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution and reproduction in any medium, provided the original author and source are credited.
This article brings forward advancements in diagnosing and managing portal hypertension. We're seeing better non-invasive tools, particularly liver stiffness measurements, and a clearer understanding of the underlying causes, which helps us aim treatments more precisely. The review covers the latest in medication and endoscopic approaches, stressing the importance of knowing a patient's risk early on. [1] Here's the thing about non-selective beta-blockers in portal hypertension: this review dives deep into how they work, how well they prevent initial and recurrent variceal bleeding, and what their safety profile looks like. It's a comprehensive look at the evidence, helping clinicians decide who benefits most and what to watch out for, reinforcing their ongoing role in care. [2] The Baveno VII Consensus Workshop has put out updated recommendations for managing variceal bleeding, a major hurdle with portal hypertension. What this really means is a more personalized approach based on individual risk, quickly starting vasoactive drugs, getting endoscopic treatment underway, and using prophylactic antibiotics smart. It also lays out strategies for preventing recurrence and what to do when initial treatments aren't enough. [3] Let's break down the non-invasive assessment of portal hypertension. This review shows how we're moving beyond just hepatic venous pressure gradient measurements. Techniques like liver and spleen stiffness, ratios involving platelet count and spleen diameter, and new biomarkers are all being explored. The idea is to make smarter clinical decisions and track treatment effectiveness without invasive procedures. [4] When it comes to managing tough complications of portal hypertension, the Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a key player. This article looks at TIPS as an intervention for problems like stubborn variceal bleeding and ascites that just won't quit. It covers who's a good candidate, what to expect during the procedure, and how to handle any issues that come up, confirming its value for certain patients. [5] This review sheds light on the incredibly intricate and shifting factors that cause portal hypertension. It's not just one thing; there's increased resistance within the liver, more blood flow to the portal system, and systemic inflammation all playing a part. The advances in understanding the precise cell and molecular mechanisms, like how liver cells and stellate cells behave, are pointing us toward exciting new treatment targets. [6] The article zeroes in on how portal hypertension behaves in acute-on-chronic liver failure (ACLF), a condition that's really dangerous. It explains how a sudden worsening of liver function can make portal hypertension and its complications even worse. We learn about the tricky parts of diagnosing it in ACLF patients and the treatment approaches, including how liver support systems and early transplants fit in. [7] This is another important set of recommendations from Baveno VII, this time tackling portal vein thrombosis (PVT), a serious complication of portal hypertension. It provides current guidance on identifying, assessing the risk, and treating PVT, including when and how to use anticoagulants. The key takeaway is that spotting PVT early can stop it from getting worse and improve outcomes for people with cirrhosis. [8] Thinking about the pharmacological side of portal hypertension, this review gives us a broad overview of current medications, mainly beta-blockers and vasodilators, and glimpses into what's coming next. It details how these drugs lower portal pressure and prevent complications. What it also does is highlight the ongoing challenges and exciting possibilities for developing more effective and precisely targeted treatments. [9] This article offers a really specific look at portal hypertension in children, which has its own unique set of causes like birth defects or blockages outside the liver, quite different from adults. It walks through how to diagnose it in kids and age-appropriate ways to manage it, including endoscopic treatments and surgical shunts. The big takeaway is the critical need for specialized care when treating children. [10]
Recent advancements in diagnosing and managing portal hypertension are transforming clinical practice. Non-invasive assessment methods are increasingly important, moving beyond invasive hepatic venous pressure gradient measurements. Techniques like liver and spleen stiffness, along with specific ratios involving platelet count and spleen diameter, are being explored to guide smarter clinical decisions and track treatment effectiveness without needing invasive procedures [C001, C004]. Understanding the underlying causes of this complex condition more clearly helps tailor treatments precisely [C001].
The pathophysiology of portal hypertension is incredibly intricate and multifactorial [C006]. It involves increased resistance within the liver, coupled with heightened blood flow to the portal system, all exacerbated by systemic inflammation. Recent insights into the precise cellular and molecular mechanisms, especially how liver and stellate cells behave, are opening doors to exciting new treatment targets [C006]. This deeper understanding is crucial for developing more effective therapies.
Management strategies encompass a range of pharmacological and interventional approaches. Non-selective beta-blockers are a cornerstone in care, with extensive reviews detailing their mechanism, efficacy in preventing initial and recurrent variceal bleeding, and safety profile [C002, C009]. Beyond current medications, the pharmacological landscape continues to evolve, with ongoing challenges and possibilities for developing more targeted treatments [C009]. For tough complications like stubborn variceal bleeding and ascites, the Transjugular Intrahepatic Portosystemic Shunt (TIPS) serves as a key intervention, requiring careful candidate selection and management of potential issues [C005].
Addressing severe complications is central to care. The Baveno VII Consensus Workshop has provided updated recommendations for managing variceal bleeding, emphasizing a personalized approach, rapid initiation of vasoactive drugs, timely endoscopic treatment, and the judicious use of prophylactic antibiotics [C003]. This workshop also outlines strategies for preventing recurrence and managing cases where initial treatments prove insufficient [C003]. Additionally, Baveno VII has issued guidance for portal vein thrombosis (PVT), a serious complication, covering identification, risk assessment, and treatment with anticoagulants, underscoring the benefit of early detection for improved outcomes in patients with cirrhosis [C008].
Portal hypertension presents unique challenges in specific populations and contexts. Its behavior in Acute-on-Chronic Liver Failure (ACLF) is particularly dangerous, where a sudden worsening of liver function can severely exacerbate portal hypertension and its complications [C007]. Diagnosing and treating it in ACLF patients involves complex approaches, including liver support systems and early transplants [C007]. Furthermore, portal hypertension in children requires specialized care due to its distinct etiologies, often involving birth defects or extrahepatic blockages, demanding age-appropriate diagnostic and management strategies such as endoscopic treatments and surgical shunts [C010].
The provided literature offers a comprehensive overview of recent advancements in understanding, diagnosing, and managing portal hypertension. This includes significant strides in non-invasive assessment, utilizing tools like liver stiffness measurements and novel biomarkers, which refine clinical decision-making and reduce the need for invasive procedures. There's a clearer picture of the underlying pathophysiology, encompassing intrahepatic resistance, portal blood flow, and systemic inflammation, with a focus on cellular and molecular mechanisms guiding new treatment targets. Key management strategies are highlighted, such as the continued importance of non-selective beta-blockers for variceal bleeding prevention, and the role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) for refractory complications like variceal bleeding and ascites. Consensus guidelines, specifically Baveno VII, provide updated, personalized recommendations for managing acute events like variceal bleeding and serious complications such as portal vein thrombosis, stressing early intervention and tailored therapies. The data also addresses unique challenges in specific populations, detailing the complexities of portal hypertension in Acute-on-Chronic Liver Failure (ACLF) and the distinct diagnostic and management considerations for pediatric patients, emphasizing the need for specialized care. Overall, these insights point to a dynamic field driven by continuous research to enhance precision in diagnosis and efficacy in treatment, ultimately improving patient outcomes.
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Hepatology and Pancreatic Science received 34 citations as per Google Scholar report
