Skip to main content
SpringerLink
Log in

Management of portal hypertension

  • Symposium on Hepatology-III
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Portal hypertension (PHT) is common in children and a majority of cases in India are constituted by extrahepatic portal venous obstruction or cirrhosis of liver. Morbidity and mortality in this condition is related to variceal bleeding, most commonly from esophageal varices. Acute variceal bleeding is best controlled by endoscopic therapy. Somatostatin and octreotide are useful in acute variceal bleeding as a supplementary therapy. Acute variceal bleeding uncontrolled by medical therapy merits preferably a shunt surgery or devascularization depending upon etiology of PHT and expertise of the surgeon. Acute variceal bleeding originating from gastric varices can be effectively controlled by endoscopic injection of tissue adhesive agent (n-butyl 2 cyanoacrylate). Eradication of esophageal varices by endoscopie measures (sclerotherapy or band ligation) is successful in prevention of recurrence of bleeding. Surgical portosystemic shunts especially in non-cirrhotic PHT are successful in achieving portal decompression and significant reduction in recurrence of variceal bleeding. Role of beta-blockers in primary prophylaxis of variceal bleeding in children still remains to be substantiated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alex P Mowat. Disorders of the portal and the hepatic venous system, InLiver Disorders in Childhood 3rd edn. Oxford, Butterworth-Heinemann Ltd., 1994; 368–397.

    Google Scholar 

  2. Ravi Shankar B, Sharma BC, Yachha SK. Portal hypertension in children-an experience from a tertiary center (abstract).Indian J Pediatr 1995; 14 (S1):D8

    Google Scholar 

  3. Arora NK, Lodha R, Gulati Set al. Portal hypertension in Northern Indian children.Indian J Pediatr 1998; 65: 585–591.

    Article  PubMed  CAS  Google Scholar 

  4. Poddar U, Thapa BR, Vashishta RK, Girish CS, Singh K. Congenital hepatic fibrosis in Indian children.J Gastroenterol Hepatol 1999; 14:1192–1196.

    Article  PubMed  CAS  Google Scholar 

  5. Poddar U, Thapa BR, Puri Pet al. Non-cirrhotic portal fibrosis in children.Indian J Gastroenterol 2000; 19:12–13.

    PubMed  CAS  Google Scholar 

  6. Yachha SK, Dhiman RK, Gupta R, Ghoshal UC. Endosonographic evaluation of rectum in children with extrahepatic portal venous obstruction.J Pediatr Gastroenterol Nutr 1996; 23-. 438–441.

    Article  PubMed  CAS  Google Scholar 

  7. Yachha SK, Ghoshal UC, Gupta R, Sharma BC, A Ayyagari. Portal hypertensive gastropathy in children with extrahepatic portal venous obstruction: Role of variceal obliteration by endoscopic sclerotherapy andHelicobacter pylori infection./ Pediatr Gastroenterol Nutr 1996; 23:20–23.

    Article  CAS  Google Scholar 

  8. Yachha SK, Sharma BC, Kumar M, Khanduri A. Endoscopic sclerotherapy for esophageal varices in children with extrahepatic portal venous obstruction: a follow-up study.J Pediatr Gastroenterol Nutr 1997; 24:49–52.

    Article  PubMed  CAS  Google Scholar 

  9. De Franchis R, Primignani M. Endoscopie treatment for portal hypertension.Seminars in Liver Disease 1999; 19:499–455.

    Google Scholar 

  10. Bleau BL. Endoscopie management of the acute variceal bleeding event.Gastroenterol Endoscopy Clin North Am 1999; 9: 189–206.

    CAS  Google Scholar 

  11. Oho K, Iwao T, Sumino M, Toyonaga A, Tanikawa K. Ethanolamine oleate versus butyl-cyanoacrylate for bleeding gastric varices: A non-randomized study.Endoscopy 1995; 27: 349–354.

    PubMed  CAS  Google Scholar 

  12. Fuster S, Costaguta A, Tobacco O. Treatment of bleeding gastric varices with tissue adhesive Histoacryl in children.Endoscopy 1998; 30: S39–40.

    PubMed  CAS  Google Scholar 

  13. Tuggle DW, Bennett KG, Scott J, Tunell WP. Intravenous vasopressin and gastrointestinal hemorrhage in children.J Pediatr Surg 1988; 23:627–629.

    Article  PubMed  CAS  Google Scholar 

  14. D’Amico G, Pagliaro L, Bosch J. Pharmacological treatment of portal hypertension: An evidence based approach.Seminars in Liver Disease 1999; 19:475–505.

    PubMed  CAS  Google Scholar 

  15. Burroughs AK, McCormick PA, Hughes MDet al. Randomized double blind placebo controlled trial of somatostatin for variceal bleeding. Emergency control and prevention of early variceal bleeding.Gastroenterology 1990; 99: 1388–1395.

    PubMed  CAS  Google Scholar 

  16. DiFebo C, Siringo M, Vacirca Met al. Somatostatin (SMS) and urgent sclerotherapy in active esophageal variceal bleeding (abstract).Gastroenterology 1990; 98:583.

    Google Scholar 

  17. Sung JY, Chung S, Lai CWet al. Octreotide infusion or emergency sclerotherapy for variceal hemorrhage.Lancet 1993; 342:637–641.

    Article  PubMed  CAS  Google Scholar 

  18. Poo JL, Bosques F, Garduno Retal. Octreotide versus emergency sclerotherapy in acute variceal hemorrhage in liver cirrhosis. A randomized multicenter study.Gastroenterology 1996; 110: A1297.

    Google Scholar 

  19. Pitcher JL. Safety and effectiveness of the modified Sangstaken-Blackemore tube. A prospective study.Gastroenterology 1971; 61:291–298.

    PubMed  CAS  Google Scholar 

  20. Brodoff M, Conn HO. Esophageal tamponade in the management of bleeding esophageal varices.Dig Dis Sci 1980; 25:267–272.

    Article  Google Scholar 

  21. Heyman’ MB, LaBerge JM. Role of transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension in pediatric patients.J Pediatr Gastroenterol Nutr 1999; 29:209–249.

    Google Scholar 

  22. Uchiyama M, Iwafuchi M, Ohsawa Yetal. Long term results after non-shunt operations for esophageal varices in children.J Pediatr Surg 1994; 29:1429–1433.

    Article  PubMed  CAS  Google Scholar 

  23. Howard ER, Stringer MD, Mowat AP. Assessment of injection sclerotherapy in management of 152 children with esophageal varices.Br J Surg 1988; 75:404–408.

    Article  PubMed  CAS  Google Scholar 

  24. Dilawari JB, Chawla YK, Ramesh GN, Mitra SK, Walia BNS. Endoscopie sclerotherapy in children.J Gastroenterol Hepatol 1989; 4:155–160.

    Article  PubMed  CAS  Google Scholar 

  25. Maksaud JG, Goncalves MEP, Porta G, Miura I, Velhote MCP. The endoscopie and surgical management of portal hypertension in children: Analysis of 123 cases.J Peditr Surg 1991; 26:178–181.

    Article  Google Scholar 

  26. Hill ID, Bowie MD. Endoscopie sclerotherapy for control of bleeding varices in children.Am J Gastroenterol 1991; 86:472–476.

    PubMed  CAS  Google Scholar 

  27. Fox VI, Carr-Locke Dl, Cannors PJ, Leichtnes AM. Endoscopie ligation of esophageal varices in children.J Pediatr Gastroenterol Nutr 1995; 20:202–208.

    Article  PubMed  CAS  Google Scholar 

  28. Cano I, Urruzonu P, Medina E, Vilarino A, Benavent MI, Manzanares Jet al. Treatment of esophageal varices by endoscopie ligation in children.Eur J Pediatr Surg 1996; 31: 10576–10579.

    Google Scholar 

  29. Rikkers LF, Sorrell T, Gongliang J. Which portosystemic shunt is best?:Gastroenterol Clin North Am 1992; 21:179–196.

    PubMed  CAS  Google Scholar 

  30. Orloff MJ, Orloff MS, Rambotti M. Treatment of bleeding esophagogastric varices due to extrahepatic portal hypertension: Results of Portosystemic shunts during 35 years.J Pediatr Surg 1994; 29:142–154.

    Article  PubMed  CAS  Google Scholar 

  31. Chaudhary A, Tatke M, Aranya RC: Endoscopie schlerotherapy: the far and near effects.BrJ Surg 1990; 77:963.

    Article  CAS  Google Scholar 

  32. Bambini DA, Superina R, Almond PS, Whitington PF, Alonso E. Experience with the Rex (Mesenterico-Left portal Bypass) in children with Extrahepatic portal hypertension.J Pediatr Surg 2000; 35:13–19.

    Article  PubMed  CAS  Google Scholar 

  33. Bismuth H, Franco D, Alagille D. Portal diversion for portal hypertension in children. The first ninety patients.Ann. Surg 1980; 192:18–24.

    Article  PubMed  CAS  Google Scholar 

  34. Alvarez F, Bernard O, Brunelle Fet al. Portal obstruction in children, n. Results of surgical portosystemic shunts.J Pediatr 1983; 103:703–707.

    Article  PubMed  CAS  Google Scholar 

  35. Prasad AS, Gupta S, Kohli V, Pande GK, Sahni P, Nundy S. Proximal Splenorenal shunts for extrahepatic portal venous obstruction in children.Ann Surg 1994; 219:193–196.

    Article  PubMed  CAS  Google Scholar 

  36. Kato T, Romero R, Koutouby Ret al. Portosystemic shunting in children during the era of endoscopie therapy: Improved post operative growth parameters.J Pediatr Gastroenterol Nutr 2000; 30:419–125.

    Article  PubMed  CAS  Google Scholar 

  37. Mitra SK, Rao KLN, Narashnhan KLet al. Side-to-side Lienorenal Shunt without splenectomy in Noncirrhotic Portal Hypertension in Children.JPediatr Surg 1993; 28:398–402.

    Article  CAS  Google Scholar 

  38. Ozsoylu S, Kocak N, Demir H, Yuce A, Gurakan F, Ozen H. Propranolol for primary and secondary prophylaxis of variceal bleeding in children with cirrhosis.Turk J Peidtr 2000; 42: 31–33.

    CAS  Google Scholar 

  39. Goncalves MEP, Cardoso SR, Maksoud JG. Prophylactic sclerotherapy in children with esophageal varices: Long term results of controlled prospective randomized trial.J Pediatr Surg 2000; 35:401–405.

    Article  PubMed  CAS  Google Scholar 

  40. Sarin SK, Guptan RC, Jain A, Sundaram KR. A randomized controlled trial of endoscopic variceal band ligation for primary prophylaxis of variceal bleeding.Eur J Gastroenterol Hepatol 1996; 8:337–342.

    Article  PubMed  CAS  Google Scholar 

  41. Lay CS, Tsi YT, Teg CYet al. Endoscopic variceal ligation in prophylaxis of first variceal bleeding in cirrhotic patients with high risk esophageal varices.Hepatology 1997; 25:1346–1350.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Author notes

  1. S. K. Yachha (Additional Professor)

    Present address: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, 226014, Lucknow, India

Authors and Affiliations

  1. Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, 226014, Lucknow, India

    Kamal Chetri

  2. Department of Surgical Gastroenterologe, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

    Richa Lal

Authors
  1. S. K. Yachha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kamal Chetri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richa Lal
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yachha, S.K., Chetri, K. & Lal, R. Management of portal hypertension. Indian J Pediatr 69, 809–813 (2002). https://doi.org/10.1007/BF02723696

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02723696

Key words

Search

Navigation