Can portal hypertension be treated? What does it all involve?

The aim of treatment is to prevent acute bleeding and its recurrence. It includes pharmacological treatment, where beta-blockers reduce the flow through the portal vein. In addition, hepatoprotective agents are added to improve liver function.

In the case of high-risk varices, they are treated by an endoscopic approach, namely ligation - ligation of the vascular aneurysm and their sclerotization.

In case of bleeding, several procedures are available:

1. blood volume replenishment
2. drugs to reduce bleeding, blood clotting - haemostatics, vasopressin
3. gastroscopy - finding the source of bleeding
4. Esophageal variceal tamponade - SB probe (Sengstaken Balekmore probe) is designed to prevent bleeding from a blood vessel by squeezing it. It contains two balloons, one presses on the stomach opening and the other seals the varix in the esophagus

Electrical sclerotisation and bandaging are intended to reduce the risk of bleeding. However, they do not address the high blood pressure in the oesophagus.

The formation of ascites (water in the abdomen) is reduced by administering diuretics and limiting salt intake. In the case of a large mass, part of the contents are removed by puncture. This involves inserting a needle through the skin.

Liver transplantation is necessary in the case of liver failure and in the case of cirrhosis, which is irreversible. Although the liver is capable of regeneration, at some point and with the transformation of functional tissue into fibrotic tissue, this may no longer be the case.

In the case of tumours, surgical removal is an option. However, this is not possible in all cases.

Unfortunately, treatment is not always successful. In unsuccessful cases, the patient is given a palliative form. This is intended to improve quality and length of life as much as possible.

TIPS, DSRS and the MESO-REX method

TIPS (transjugular intrahepatic portosystemic shunt) is an artificially created shunt. It leads through the vena jugularis (jugular vein) and the hepatic veins to the trunk of the portal vein.

It is mainly chosen for variceal bleeding and its recurrence or ascites. It is performed under radiological control through the vessels. It is not a surgical procedure.

The disadvantage is the possible acceleration of the onset of encephalopathy in case of significant liver involvement. As it partially bypasses the liver, the amount of toxins in the blood increases.

DSRS (distal splenorenal shunt) is a surgical procedure. The splenic vein is separated from the portal system and connected to the renal vein. This reduces the pressure in the portal vein.

The MESO-REX BY-PASS, or Rex shunt, is an effective treatment for thrombosis and other portal vein anomalies in children. It involves creating a shunt (bypass) of the blocked portal vein.

This is a shunt between the superior mesenteric vein (HMV), which supplies blood from the intestine, and the left portal vein. The functional patency of the mesenteric vein is important in this method.

It connects the mesenteric vein to a branch of the left portal vein. The shunt uses its own vein, which may come from several sources, often the internal jugular vein.

This method has advantages, especially in paediatric patients. It should be used before more severe symptoms of portal hypertension appear.

Prevention

In this case, a total change in lifestyle is necessary. Total restriction of alcohol, drugs, drugs that burden the liver (paracetamol), but also the inclusion of dietary supplements that promote liver regeneration.

Any treatment and the use of dietary supplements should be consulted with a specialist.

Dietary modification is necessary, limiting sodium (salt) to a maximum of 2 g per day. Dietary restriction may also include protein restriction and control of fluid intake.