[Diagnosis and therapy of portal hypertension]

Abstract

Portal hypertension, defined by a constant increase of the portal vein pressure over 5 to 10 mmHg, is usually caused by a pre-, intra- or posthepatic obstruction of the portal blood flow. Advances in ultrasound techniques like duplex or colour doppler enabled portal hypertension to be diagnosed safely in a noninvasive way. Invasive procedures for the measurement of portal pressure or blood flow are just applied for scientific and pharmacological questions. The therapy of portal hypertension concentrates on the treatment of its complications: The management of the acute variceal hemorrhage should follow a sequential regime. The treatment of the individual patient however, depends on the special experiences of the responsible doctor. In the primary and secondary prophylaxis of hemorrhage from esophageal varices the administration of portal pressure reducing agents like beta-blockers, sclerotherapy or banding of esophageal varices, represent effective strategies. Trials in the future should concentrate on the characterization of these patients, who show the best response to different prophylactic strategies. The treatment of ascites is according to a sequential procedure. Peritoneovenous shunts are usually not necessary. The transhepatic intrajugular portosystemic stent shunt offers a new therapeutic option of complications of portal hypertension. First studies show encouraging results.