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Mehmet Arhan - One of the best experts on this subject based on the ideXlab platform.
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Left-Sided Portal Hypertension
Digestive Diseases and Sciences, 2007Co-Authors: Seyfettin Köklü, Şahin Çoban, Osman Yüksel, Mehmet ArhanAbstract:Left-sided Portal Hypertension is a rare clinical syndrome which may lead to bleeding from isolated gastric varices. Pancreatic disease is the most common etiology. Left-sided Portal Hypertension should be considered in the presence of gastrointestinal bleeding with normal liver function and unexplained splenomegaly. It may be difficult to diagnose this entity both endoscopically and radiologically. While splenectomy is the treatment of choice for cases complicated by variceal bleeding, there is no consensus on the treatment of asymptomatic patients. The prognosis of left-sided Portal Hypertension mainly depends on the underlying etiology.
Didier Lebrec - One of the best experts on this subject based on the ideXlab platform.
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Pathogenesis of Portal Hypertension.
European journal of gastroenterology & hepatology, 2001Co-Authors: Didier Lebrec, Richard MoreauAbstract:Portal Hypertension is defined by an elevation in Portal pressure and is associated with haemodynamic alterations. Haemodynamic changes are characterized by a hyperdynamic circulation in the splanchnic and systemic territories and a reduced pressure effect of vasoconstrictive substances. They were observed in both patients and animals with different types of Portal Hypertension. In this review, the main results and their mechanisms of the splanchnic and systemic haemodynamic alterations in Portal Hypertension are discussed.
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Noncirrhotic Portal Hypertension.
Clinics in liver disease, 1997Co-Authors: Sophie Hillaire, Dominique Valla, Didier LebrecAbstract:This article reviews the different conditions leading to noncirrhotic intrahepatic Portal Hypertension, describes the related vascular lesions, and provides a review of the clinical characteristics, diagnosis, and treatment options available. Diseases associated with noncirrhotic Portal Hypertension are also specifically discussed.
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2 Evaluation of patients with Portal Hypertension
Bailliere's clinical gastroenterology, 1997Co-Authors: Didier Lebrec, Philippe Sogni, Valérie VilgrainAbstract:Abstract Patients with suspected Portal Hypertension must first be evaluated by physical examination, upper digestive endoscopy and ultrasonography with Doppler. Moreover, the evaluation of patients with Portal Hypertension depends on the cause of Portal Hypertension, the presence of complications and the specific treatment considered. Haemodynamic assessment with measurement of the hepatic venous pressure gradient is useful in confirming the origin of Portal Hypertension. This technique is the ‘gold-standard’ for evaluating haemodynamic treatments. Splanchnic and systemic circulation must also be measured. Quantitative evaluation of the splanchnic territory by Doppler sonography and other non-invasive investigations, may be performed. Further clinical studies are, however, needed to determine their interest in Portal Hypertension.
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Clinical Manifestations of Portal Hypertension
Portal Hypertension, 1991Co-Authors: Antoine Hadengue, Didier Lebrec, Jean-pierre BenhamouAbstract:Portal Hypertension, like systemic arterial Hypertension, may be clinically latent and is usually diagnosed under three circumstances. First, in patients with chronic liver disease, clinical evaluation, ultrasound, and endoscopic studies are performed to evaluate the presence and consequences of Portal Hypertension. Second, Portal Hypertension may be discovered during esophageal endoscopy, disclosing esophageal varices, or during abdominal ultrasound, showing splenomegaly and Portal-systemic collaterals. Third, Portal Hypertension is often discovered due to its complications, usually ascites or an episode of gastrointestinal bleeding, but rarely hepatic encephalopathy. Less frequent complications are hypoxia, pulmonary arterial Hypertension, arterial aneurysms, and alterations in drug disposition (Table 19.1.)
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Animal Models of Portal Hypertension
Portal Hypertension, 1991Co-Authors: Didier LebrecAbstract:Experimental studies in Portal Hypertension have markedly increased in number in the past 10 years. The causes of this increase are related to new theories concerning splanchnic hemodynamic alterations due to Portal Hypertension. Recent pharmacologic treatment of Portal Hypertension and new methods for measuring splanchnic organ blood flow have also contributed to the development of this area. Moreover, it is clear that animal models of Portal Hypertension give more information on hemodynamic changes than studies in Portal hypertensive patients, since at this time, it is impossible to measure splanchnic organ blood flows in these patients. Most studies have been performed in vivo, although in vitro models, such as perfused liver or isolated vessels, have been used to evaluate intrahepatic Portal resistance [1] or vascular reactivity, respectively. Splanchnic circulation differs from one species to another. Baboons and rats seem to be the most appropriate species for experimentation since their splanchnic circulation is very similar to humans. Dogs have been widely used for hemodynamic studies but have many anatomic differences from man. In this chapter, the main animal models used to study Portal Hypertension are described, and the hemodynamic methods and consequences of Portal Hypertension in these models are reported.
Guadalupe Garcia-tsao - One of the best experts on this subject based on the ideXlab platform.
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Future Pharmacological Therapies of Portal Hypertension
Current Hepatology Reports, 2019Co-Authors: Guillermo A. Ortiz, Guadalupe Garcia-tsaoAbstract:Purpose of Review To provide an overview of recent pharmacological treatments for Portal Hypertension evaluated in early clinical trials, with particular emphasis on the pathophysiological basis of their use. Recent Findings In patients with compensated cirrhosis, even small decreases in Portal pressure (as small as 1 mmHg) are associated with a lower probability of decompensation. In patients with decompensated cirrhosis, Portal pressure “response” to non-selective beta-blocker (NSBB) therapy is associated with a lower mortality. When present, significant Portal Hypertension persists even after the elimination of the etiology of cirrhosis and this justifies the continued development of new drugs that target Portal Hypertension. Summary Over several decades, we have gained great depth in the understanding of Portal Hypertension, its mechanisms and complications. NSBBs, which act by reducing Portal venous inflow (an extrahepatic target), are effective in reducing Portal pressure and have been the mainstay of therapy for Portal Hypertension in the last 35 years—being effective in preventing decompensation and variceal hemorrhage. However, because not all patients will have a sufficient response to NSBB and some may be intolerant to NSBB, alternative drugs or drugs that will augment the effect of NSBB on Portal pressure are being tested in pre-clinical and early-clinical trials. Many of these drugs target more than one of the intrahepatic or extrahepatic mechanisms implicated in the pathogenesis of Portal Hypertension in cirrhosis. Out of these proposed therapies, statins have emerged as the most promising new pharmacological therapy for the treatment of Portal Hypertension.
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Clinical Pharmacology of Portal Hypertension
Gastroenterology clinics of North America, 2010Co-Authors: Cecilia Miñano, Guadalupe Garcia-tsaoAbstract:Portal Hypertension is an increase in pressure in the Portal vein and its tributaries. It is defined as a Portal pressure gradient (the difference in pressure between the Portal vein and the hepatic veins) greater than 5 mm Hg. Although this gradient defines Portal Hypertension, a gradient of 10 mm Hg or greater defines clinically significant Portal Hypertension, because this pressure gradient predicts the development of varices, decompensation of cirrhosis, and hepatocellular carcinoma. The most direct consequence of Portal Hypertension is the development of gastroesophageal varices that may rupture and lead to the development of variceal hemorrhage. This article reviews the pathophysiologic bases of the different pharmacologic treatments for Portal Hypertension in patients with cirrhosis and places them in the context of the natural history of varices and variceal hemorrhage.
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Portal Hypertension.
Current opinion in gastroenterology, 2006Co-Authors: Guadalupe Garcia-tsaoAbstract:Significant advances in the pathophysiology, diagnosis and management of the complications of Portal Hypertension that have occurred in the last year are reported. The specific areas reviewed are those that refer to experimental studies aimed at modifying the factors that lead to Portal Hypertension (increased intrahepatic vascular resistance and splanchnic vasodilatation) and recent advances in the diagnosis and management of the complications of Portal Hypertension. The specific complications reviewed in this paper are varices and variceal bleeding (primary prophylaxis, treatment of the acute episode and secondary prophylaxis), ascites and hepatorenal syndrome, spontaneous bacterial peritonitis and hepatic encephalopathy, as well as recent studies of predictors of death in cirrhosis. Important studies, mostly prospective, regarding the management of the complications of Portal Hypertension are reviewed, including a trial of beta-blockers in the prevention of varices, a randomized trial of endoscopic variceal ligation plus nadolol in preventing recurrent variceal bleeding and several meta-analyses on trials comparing large-volume paracentesis with transjugular intrahepatic portosystemic shunt in the management of refractory ascites.
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Portal Hypertension.
Current opinion in gastroenterology, 2005Co-Authors: Guadalupe Garcia-tsaoAbstract:Report on significant advances in the pathophysiology, diagnosis, and management of the complications of Portal Hypertension that have occurred in the last year. The specific areas reviewed refer to experimental studies aimed at modifying the factors that lead to Portal Hypertension (increased intrahepatic vascular resistance and splanchnic vasodilatation) and recent advances in the diagnosis and management of the complications of Portal Hypertension. The specific complications reviewed in this paper are varices and variceal bleeding (primary prophylaxis, treatment of the acute episode, and secondary prophylaxis), ascites and some of its complications (hyponatremia, hepatic hydrothorax), hepatorenal syndrome, spontaneous bacterial peritonitis, and hepatic encephalopathy. Important studies, mostly prospective, regarding the management of the complications of Portal Hypertension are reviewed, including trials that demonstrate the value of the hepatic venous pressure gradient in predicting these complications, a trial of beta-blockers in patients with small varices, a randomized trial of transjugular intrahepatic portosystemic shunt using covered stents and another pilot study using this shunt in the treatment of hepatorenal syndrome, a trial of antibiotic prophylaxis in preventing early variceal rebleeding, and a trial of synbiotic therapy in hepatic encephalopathy. These trials will contribute to advancing the practice of hepatology and defining future research areas.
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Portal Hypertension.
Current opinion in gastroenterology, 2004Co-Authors: Guadalupe Garcia-tsaoAbstract:This review discusses the advances in the pathophysiology, diagnosis, and management of the complications of Portal Hypertension that have occurred in the past year. The specific topics reviewed are the pathophysiology of Portal Hypertension (including recent findings regarding intrahepatic vascular resistance and splanchnic vasodilatation) and experimental methods used to act on the mechanisms that lead to Portal Hypertension, as well as recent advances in the diagnosis and management of the complications of Portal Hypertension. The specific complications discussed in this review are varices and variceal bleeding (primary prophylaxis, treatment of the acute episode, and secondary prophylaxis), Portal hypertensive gastropathy, ascites, hepatorenal syndrome, spontaneous bacterial peritonitis, the cardiopulmonary complications of Portal Hypertension (hepatopulmonary syndrome, portopulmonary Hypertension, cardiac dysfunction), and hepatic encephalopathy.
Arun J. Sanyal - One of the best experts on this subject based on the ideXlab platform.
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Portal Hypertension and Its Complications
Gastroenterology, 2008Co-Authors: Arun J. Sanyal, Jaime Bosch, Andres T. Blei, V. ArroyoAbstract:Portal Hypertension is a clinical syndrome defined by a Portal venous pressure gradient exceeding 5 mm Hg. 1 Cirrhosis is the most common cause of Portal Hypertension in the Western world.' The goal of this review is to provide an overview of the current understanding of the pathophysiology and treatment of Portal Hypertension.
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Portal Hypertension and variceal hemorrhage.
The Medical clinics of North America, 2008Co-Authors: Nagib Toubia, Arun J. SanyalAbstract:Portal Hypertension, a major hallmark of cirrhosis, is defined as a Portal pressure gradient exceeding 5 mm Hg. In Portal Hypertension, porto-systemic collaterals decompress the Portal circulation and give rise to varices. Successful management of Portal Hypertension and its complications requires knowledge of the underlying pathophysiology, the pertinent anatomy, and the natural history of the collateral circulation, particularly the gastroesophageal varices.
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Pregnancy and Portal Hypertension
Portal Hypertension, 2005Co-Authors: Bimaljit S. Sandhu, Arun J. SanyalAbstract:Pregnancy is a normal physiological state characterized by numerous hemodynamic changes. These hemodynamic changes, although necessary for a normal pregnancy, pose a special problem in the presence of Portal Hypertension. In North America, cirrhosis of the liver is the most common cause of Portal Hypertension. Although rare, the occurrence of pregnancy is not altogether unknown in this population. This is caused by reduced fertility as a consequence of anovulatory cycles, altered endocrine metabolism, and a relatively older age of these patients (1, 2, 3, 4, 5, 6). Most women with well-compensated early chronic liver disease and those with the liver disease in remission, can expect to have normal fertility (3,7). Subjects with liver diseases that progress slowly, such as primary biliary-cirrhosis, are particularly likely to have preserved fertility until the disease becomes quite advanced (8, 9, 10, 11, 12). Also, in patients with noncirrhotic Portal Hypertension (NCPH) the hepatic synthetic functions are relatively well preserved and so is the fertility (13,14). Pregnancy in a patient with Portal Hypertension is a unique problem that needs specialized care to prevent potentially life-threatening complications such as gastrointestinal hemorrhage, it is therefore important to understand the effect of pregnancy on Portal Hypertension and vice versa so that untoward incidents like fetal morbidity and mortality and gastrointestinal hemorrhage can be avoided.
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PREGNANCY IN A PATIENT WITH Portal Hypertension
Clinics in Liver Disease, 1999Co-Authors: Sudhakar Misra, Arun J. SanyalAbstract:Portal Hypertension results from obstruction to flow within the Portal circulation. Such obstruction may occur at a presinusoidal level (e.g., in the Portal vein), the hepatic sinusoids (e.g., in cirrhosis), and at a postsinusoidal level (e.g., Budd-Chiari syndrome). Cirrhosis and advanced liver failure frequently are associated with amenorrhea and infertility, 33 whereas most patients with presinusoidal Portal Hypertension have a structurally and functionally normal liver. 60 In the West, 62 Portal vein thrombosis is the most common cause of presinusoidal Portal Hypertension, whereas schistosomiasis dominates as the most common cause of Portal Hypertension worldwide. Such patients can and often do become pregnant. 44,69 There also are specific liver diseases associated with Portal Hypertension (e.g., primary biliary cirrhosis, 70 biliary atresia, 37 and sclerosing cholangitis 30 ), which progress slowly and are associated with relatively preserved fertility until liver failure develops. Finally, some women with well-compensated cirrhosis continue to ovulate normally and can become pregnant. 30,43,49 Management of pregnant women with Portal Hypertension requires consideration of both the effects of pregnancy on Portal hemodynamics and liver disease and the effects of Portal Hypertension and its cause on the mother and child.
Seyfettin Köklü - One of the best experts on this subject based on the ideXlab platform.
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Left-Sided Portal Hypertension
Digestive Diseases and Sciences, 2007Co-Authors: Seyfettin Köklü, Şahin Çoban, Osman Yüksel, Mehmet ArhanAbstract:Left-sided Portal Hypertension is a rare clinical syndrome which may lead to bleeding from isolated gastric varices. Pancreatic disease is the most common etiology. Left-sided Portal Hypertension should be considered in the presence of gastrointestinal bleeding with normal liver function and unexplained splenomegaly. It may be difficult to diagnose this entity both endoscopically and radiologically. While splenectomy is the treatment of choice for cases complicated by variceal bleeding, there is no consensus on the treatment of asymptomatic patients. The prognosis of left-sided Portal Hypertension mainly depends on the underlying etiology.
