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Portal hypertension and variceal bleeding 

Portal hypertension and variceal bleeding
Chapter:
Portal hypertension and variceal bleeding
Author(s):

Marcus Robertson

, and Peter Hayes

DOI:
10.1093/med/9780198746690.003.0319
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date: 27 February 2021

Portal hypertension refers to a pathological elevation of pressure in the veins that carry blood from the splanchnic organs to the liver which, in developed countries, most commonly results from increased intrahepatic resistance to portal flow as a result of liver cirrhosis. Portal hypertension is associated with development of many of the complications of cirrhosis and confers a poor prognosis. Acute variceal bleeding is a life-threatening medical emergency which remains a leading cause of death in patients with cirrhosis. Endoscopic variceal ligation and endoscopic variceal obturation remain the treatments of choice for bleeding oesophageal and gastric varices respectively. Advances in care including prophylactic antibiotics, vasoactive drugs, and transjugular intrahepatic portosystemic shunt in patients with bleeding refractory to early endoscopic management has improved the mortality rate, which is now estimated at 15 to 20%. Secondary prophylaxis of variceal bleeding with nonselective β‎-blockers and/or endoscopic variceal ligation reduces recurrent bleeding and has been demonstrated to improve survival.

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