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Disease Information : PH : Treatment

Portal Hypertension : Treatment

Treatment Options

Medical treatment of portal hypertension includes beta-blockers,which are known to many as drugs to improve blood pressure and heart function. This class of drugs helps to decrease blood flow into the portal-vein system and to decrease the pressure. Beta-blockers also reduce the risk of bleeding from varices.

Minimally invasive procedures such as endoscopic variceal sclerotherapy (EVS), which involves the injection of a solution to seal the bleeding, and endoscopic variceal banding (EVB), which is the placement of a band from inside the esophagus to seal the bleeding, are used to stop bleeding from varices. 

Another solution for portal hypertension is a procedure known as transjugular intrahepatic portasystem shunt (TIPS) This procedure inserts a stent (a hollow wire tube) between a hepatic vein  and a  branch of the portal vein. The stent passes through the liver to connect these two vascular structures. With TIPS, blood moves through the stent and bypasses the liver. This procedure has both advantages and disadvantages. TIPS reduces portal-vein pressure and bleeding from varices. However, because some blood bypasses the liver, some wastes are not cleared from the bloodstream. These nitrogen-containing compounds can cause confusion, which has to be treated with medications.

Some health professionals feel that there is no proof that someone lives longer after the TIPS procedure, that it is expensive and has a high failure rate within one year because the stent often becomes narrowed or blocked.

Othe professionals believe that TIPS is the definitive lifesaving procedure for acute massive variceal hemorrhage at many institutions. While the TIPS procedure may be expensive, it is no more so than the other procedures described. TIPS did have a failure rate, but that is for the most part historical and misleading, Today TIPS is done with covered stents and patients are followed with ultrasound for restenosis. While many patients who have uncovered stents will have restenosis, this is caught on a surveillance program and easily remedied with balloon angioplasty

Another treatment of portal hypertension is surgical shunting, a more invasive procedure than TIPS. However, some believe that surgical shunts, particularly in certain locations, improve long-term survival with portal hypertension. The only way to fully cure portal hypertension is with a liver transplant, which is expensive and afterward the patient needs life- long medical attention. With liver transplantation continuing to be a difficult solution, a better understanding of portal hypertension is required, along with earlier diagnosis and management of the disease. Transplantation does not cure all forms of portal hypertension, and any mention of transplantation must include the proviso that not all patients are candidates for transplant and the waiting period can be very long. Then, patients with portal hypertension can have a better and longer life.