The management of portal hypertension: Rational basis, available treatments and future options

Pathophysiology of portal hypertension: the different contributors to the increased portal pressure represent specific targets for therapy. Current treatments are all based on correcting the increased portal inflow. New treatments acting on the remaining determinants of portal hypertension are being actively investigated.

Meta-analysis (random effects model) of randomised controlled trials comparing endoscopic band ligation (EBL) with beta-adrenergic blockers in the prevention of first variceal bleeding. The studies have been pooled in three groups: published studies that included more than 100 patients, published studies but with less than 100 patients, and abstracts.

Prevention of variceal rebleeding: rebleeding rates with different treatment options. The bars represent median values from data reported in meta-analysis. Note the extremely low rebleeding rate in patients treated with beta-blockers and who are HVPG “responders” (fall in HVPG of at least 20% of baseline and/or to 12mmHg or below).

Algorithm of the management of acute bleeding from ruptured oesophageal varices.