Skip to main content

Austrian consensus on the definition and treatment of portal hypertension and its complications (Billroth II)

Österreichischer Konsensus zur Definition und Therapie der Portalen Hypertension und ihrer Komplikationen (Billroth II)

Wiener klinische Wochenschrift volume 125, pages 200–219 (2013)Cite this article

Summary

In November 2004, the Austrian Society of Gastroenterology and Hepatology (ÖGGH) held for the first time a consensus meeting on the definitions and treatment of portal hypertension and its complications in the Billroth-Haus in Vienna, Austria (Billroth I-Meeting). This meeting was preceded by a meeting of international experts on portal hypertension with some of the proponents of the Baveno consensus conferences (http://www.oeggh.at/videos.asp). The consensus itself is based on the Baveno III consensus with regard to portal hypertensive bleeding and the suggestions of the International Ascites Club regarding the treatment of ascites. Those statements were modified by new knowledge derived from the recent literature and also by the current practice of medicine as agreed upon by the participants of the consensus meeting. In October 2011, the ÖGGH organized the second consensus meeting on portal hypertension and its complications in Vienna (Billroth II-Meeting). The Billroth II-Guidelines on the definitions and treatment of portal hypertension and its complications take into account the developments of the last 7 years, including the Baveno-V update and several key publications.

Zusammenfassung

Im November 2004 hielt die Österreichische Gesellschaft für Gastroenterologie und Hepatologie (ÖGGH) den ersten Konsensus über die Definitionen und die Therapie der Portalen Hypertension und ihrer Komplikationen im Billroth-Haus in Wien, Österreich ab (Billroth I Meeting). Diesem Treffen ging ein internationales Expertenmeeting über die Portale Hypertension mit einigen wichtigen Proponenten der Baveno Konsensus-Konferenzen vorraus (http://www.oeggh.at/videos.asp). Der Konsensus selber basiert auf dem Baveno III Konsensus im Hinblick auf die portal-hypertensive Blutung und den Vorschlägen des International Ascites Club in Hinblick auf die Therapie des Aszites. Deren Aussagen wurden mit neuen Erkenntnissen aus der rezenten Literatur und auch entsprechend der praktischen Erfahrung der Teilnehmer des Konsensus-Treffens modifiziert. Im Oktober 2001 organisierte die ÖGGH das zweite Konsensus Treffen über die portale Hypertension und ihrer Komplikationen (Billroth II Meeting). Die Billroth II Leitlinien über die Definitionen und die Therapie der Portalen Hypertension und ihrer Komplikationen lassen die Entwicklungen der letzten 7 Jahre inklusive des Baveno V Updates und etlicher Schlüsselpublikationen mit einfließen und stellen den neuen Standard im Management der Portalen Hypertension in Österreich dar.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Fig. 1

Abbreviations

AVB:

Acute variceal bleeding

BCS:

Budd-Chiari syndrome

CSPH:

Clinically significant portal hypertension

FCB:

Failure to control bleeding

FFP:

Fresh frozen plasma

GAVE:

Gastric antral vascular ectasia

GOV:

Gastro oesophageal varices

HCC:

Hepatocellular carcinoma

HE:

Hepatic encephalopathy

HPS:

Hepatopulmonary syndrome

HRS:

Hepatorenal syndrome

HVPG:

Hepatovenous pressure gradient

IGV:

Isolated gastric varices

ISMN:

Isosorbidmononitrate

NSBB:

Nonselective beta-blockers

PPHTN:

Portopulmonary hypertension

PTFE:

Polytetrafluoroethylene

PHG:

Portal hypertensive gastropathy

TIPS:

Transjugular intrahepatic portosystemic stent

SBP:

Spontaneous bacterial peritonitis

References

  1. de Franchis R. Updating consensus in portal hypertension: report of the Baveno III consensus workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol. 2000;33:846–52.

    PubMed  Article  Google Scholar 

  2. Moore KP, Wong F, Gines P, Bernardi M, Ochs A, Salerno F, Angeli P, et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology. 2003;38:258–66.

    Google Scholar 

  3. Angermayr B, Cejna M, Peck-Radosavljevic M. Management von Patienten vor und nach Implantation eines transjugulären intrahepatischen portosystemischen Shunts (TIPS) – Bericht der Vienna TIPS Study Group. Journal für Gastroenterologische und Hepatologische Erkrankungen. 2003;1:11–4.

    Google Scholar 

  4. de Franchis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;53:762–8.

    PubMed  Article  Google Scholar 

  5. EASL. EASL clinical practice guidelines: management of hepatitis C virus infection. J Hepatol. 2011;55:245–64.

    Google Scholar 

  6. Bosch J, Garcia-Pagan JC. Complications of cirrhosis. I. portal hypertension. J Hepatol. 2000;32:141–56.

    PubMed  CAS  Article  Google Scholar 

  7. Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R, Escorsell A, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med. 2005;353:2254–61.

    PubMed  CAS  Article  Google Scholar 

  8. Garcia-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE, Glickman M. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985;5:419–24.

    PubMed  CAS  Article  Google Scholar 

  9. D’Amico G, Pagliaro L, Bosch J. Pharmacological treatment of portal hypertension: an evidence-based approach. Semin Liver Dis. 1999;19:475–505.

    Article  Google Scholar 

  10. Tripathi D, Ferguson JW, Kochar N, Leithead JA, Therapondos G, McAvoy NC, Stanley AJ, et al. Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed. Hepatology. 2009;50:825–33.

    PubMed  CAS  Article  Google Scholar 

  11. Imperiale TF, Chalasani N. A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding. Hepatology. 2001;33:802–7.

    PubMed  CAS  Article  Google Scholar 

  12. Merkel C, Bolognesi M, Sacerdoti D, Bombonato G, Bellini B, Bighin R, Gatta A. The hemodynamic response to medical treatment of portal hypertension as a predictor of clinical effectiveness in the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology. 2000;32:930–4.

    PubMed  CAS  Article  Google Scholar 

  13. Abraldes JG, Tarantino I, Turnes J, Garcia-Pagan JC, Rodes J, Bosch J. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology. 2003;37:902–8.

    PubMed  Article  Google Scholar 

  14. Tripathi D, Hayes PC. The role of carvedilol in the management of portal hypertension. Eur J Gastroenterol Hepatol. 2010;22:905–11.

    PubMed  CAS  Article  Google Scholar 

  15. Bosch J. Carvedilol for portal hypertension in patients with cirrhosis. Hepatology. 2010;51:2214–8.

    PubMed  CAS  Article  Google Scholar 

  16. Turnes J, Garcia-Pagan JC, Abraldes JG, Hernandez-Guerra M, Dell’Era A, Bosch J. Pharmacological reduction of portal pressure and long-term risk of first variceal bleeding in patients with cirrhosis. Am J Gastroenterol. 2006;101:506–12.

    PubMed  CAS  Article  Google Scholar 

  17. D’Amico G, Garcia-Pagan JC, Luca A, Bosch J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology. 2006;131:1611–24.

    Article  Google Scholar 

  18. D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–31.

    Article  Google Scholar 

  19. Banares R, Moitinho E, Matilla A, Garcia-Pagan JC, Lampreave JL, Piera C, Abraldes JG, et al. Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis. Hepatology. 2002;36:1367–73.

    PubMed  CAS  Google Scholar 

  20. Reiberger T, Ulbrich G, Ferlitsch A, Payer BA, Pinter M, Peck-Radosavljevic M. Carvedilol for prophylaxis of variceal bleeding in cirrhotic patients with hemodynamic non-response to propranolol. Hepatology. 2010;52 (Suppl 1):A21.

    Google Scholar 

  21. Garcia-Pagan JC, Morillas R, Banares R, Albillos A, Villanueva C, Vila C, Genesca J, et al. Propranolol plus placebo versus propranolol plus isosorbide-5-mononitrate in the prevention of a first variceal bleed: a double-blind RCT. Hepatology. 2003;37:1260–6.

    PubMed  CAS  Article  Google Scholar 

  22. Ben-Ari Z, Cardin F, McCormick AP, Wannamethee G, Burroughs AK. A predictive model for failure to control bleeding during acute variceal haemorrhage. J Hepatol. 1999;31:443–50.

    PubMed  CAS  Article  Google Scholar 

  23. Bernard B, Grange JD, Khac EN, Amiot X, Opolon P, Poynard T. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology. 1999;29:1655–61.

    PubMed  CAS  Article  Google Scholar 

  24. Moitinho E, Escorsell A, Bandi JC, Salmeron JM, Garcia-Pagan JC, Rodes J, Bosch J. Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology. 1999;117:626–31.

    PubMed  CAS  Article  Google Scholar 

  25. Hubmann R, Bodlaj G, Czompo M, Benko L, Pichler P, Al-Kathib S, Kiblbock P, et al. The use of self-expanding metal stents to treat acute esophageal variceal bleeding. Endoscopy. 2006;38:896–901.

    PubMed  CAS  Article  Google Scholar 

  26. Monescillo A, Martinez-Lagares F, Ruiz-del-Arbol L, Sierra A, Guevara C, Jimenez E, Marrero JM, et al. Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding. Hepatology. 2004;40:793–801.

    PubMed  Google Scholar 

  27. Garcia-Pagan JC, Caca K, Bureau C, Laleman W, Appenrodt B, Luca A, Abraldes JG, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010;362:2370–9.

    PubMed  CAS  Article  Google Scholar 

  28. Bureau C, Peron JM, Alric L, Morales J, Sanchez J, Barange K, Payen JL, et al. “A La Carte” treatment of portal hypertension: adapting medical therapy to hemodynamic response for the prevention of bleeding. Hepatology. 2002;36:1361–6.

    PubMed  Google Scholar 

  29. Primignani M, Carpinelli L, Preatoni P, Battaglia G, Carta A, Prada A, Cestari R, et al. Natural history of portal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscopic Club for the study and treatment of esophageal varices (NIEC). Gastroenterology. 2000;119:181–7.

    PubMed  CAS  Article  Google Scholar 

  30. Stewart CA, Sanyal AJ. Grading portal gastropathy: validation of a gastropathy scoring system. Am J Gastroenterol. 2003;98:1758–65.

    PubMed  Article  Google Scholar 

  31. Ward EM, Raimondo M, Rosser BG, Wallace MB, Dickson RD. Prevalence and natural history of gastric antral vascular ectasia in patients undergoing orthotopic liver transplantation. J Clin Gastroenterol. 2004;38:898–900.

    PubMed  Article  Google Scholar 

  32. Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992;16:1343–9.

    PubMed  CAS  Article  Google Scholar 

  33. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46:922–38.

    PubMed  CAS  Article  Google Scholar 

  34. Lo GH, Lai KH, Cheng JS, Chen MH, Chiang HT. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices. Hepatology. 2001;33:1060–4.

    PubMed  CAS  Article  Google Scholar 

  35. Sarin SK, Jain AK, Jain M, Gupta R. A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices. Am J Gastroenterol. 2002;97:1010–5.

    PubMed  CAS  Article  Google Scholar 

  36. Tan PC, Hou MC, Lin HC, Liu TT, Lee FY, Chang FY, Lee SD. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. Hepatology. 2006;43:690–7.

    PubMed  Article  Google Scholar 

  37. Kang EJ, Jeong SW, Jang JY, Cho JY, Lee SH, Kim HG, Kim SG, et al. Long-term result of endoscopic histoacryl (N-butyl-2-cyanoacrylate) injection for treatment of gastric varices. World J Gastroenterol. 2011;17:1494–1500.

    PubMed  CAS  Article  Google Scholar 

  38. Seewald S, Ang TL, Imazu H, Naga M, Omar S, Groth S, Seitz U, et al. A standardized injection technique and regimen ensures success and safety of N-butyl-2-cyanoacrylate injection for the treatment of gastric fundal varices (with videos). Gastrointest Endosc. 2008;68:447–54.

    PubMed  Article  Google Scholar 

  39. Akahoshi T, Hashizume M, Shimabukuro R, Tanoue K, Tomikawa M, Okita K, Gotoh N, et al. Long-term results of endoscopic histoacryl injection sclerotherapy for gastric variceal bleeding: a 10-year experience. Surgery. 2002;131:S176–81.

    PubMed  Article  Google Scholar 

  40. Kumamoto M, Toyonaga A, Inoue H, Miyakoda K, Morita Y, Emori K, Sakamoto Y, et al. Long-term results of balloon-occluded retrograde transvenous obliteration for gastric fundal varices: hepatic deterioration links to portosystemic shunt syndrome. J Gastroenterol Hepatol. 2010;25:1129–35.

    PubMed  Article  Google Scholar 

  41. Hiraga N, Aikata H, Takaki S, Kodama H, Shirakawa H, Imamura M, Kawakami Y, et al. The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration. J Gastroenterol. 2007;42:663–72.

    PubMed  Article  Google Scholar 

  42. Arai H, Abe T, Takagi H, Mori M. Efficacy of balloon-occluded retrograde transvenous obliteration, percutaneous transhepatic obliteration and combined techniques for the management of gastric fundal varices. World J Gastroenterol. 2006;12:3866–73.

    PubMed  Google Scholar 

  43. Chau TN, Patch D, Chan YW, Nagral A, Dick R, Burroughs AK. “Salvage” transjugular intrahepatic portosystemic shunts: gastric fundal compared with esophageal variceal bleeding (see comments). Gastroenterology. 1998;114:981–7.

    PubMed  CAS  Article  Google Scholar 

  44. Boyer TD, Haskal ZJ. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension: update 2009. Hepatology. 2010;51:306.

    PubMed  Article  Google Scholar 

  45. Pache I, Bilodeau M. Severe haemorrhage following abdominal paracentesis for ascites in patients with liver disease. Aliment Pharmacol Ther. 2005;21:525–9.

    PubMed  CAS  Article  Google Scholar 

  46. Boyer TD, Zia P, Reynolds TB. Effect of indomethacin and prostaglandin A1 on renal function and plasma renin activity in alcoholic liver disease. Gastroenterology. 1979;77:215–22.

    PubMed  CAS  Google Scholar 

  47. Pariente EA, Bataille C, Bercoff E, Lebrec D. Acute effects of captopril on systemic and renal hemodynamics and on renal function in cirrhotic patients with ascites. Gastroenterology. 1985;88:1255–9.

    PubMed  CAS  Google Scholar 

  48. Gentilini P, Romanelli RG, La Villa G, Maggiore Q, Pesciullesi E, Cappelli G, Casini Raggi V, et al. Effects of low-dose captopril on renal hemodynamics and function in patients with cirrhosis of the liver. Gastroenterology. 1993;104:588–94.

    PubMed  CAS  Google Scholar 

  49. Gines P, Cardenas A, Arroyo V, Rodes J. Management of cirrhosis and ascites. N Engl J Med. 2004;350:1646–54.

    PubMed  CAS  Article  Google Scholar 

  50. EASL. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53:397–417.

    Article  Google Scholar 

  51. Rimola A, Garcia-Tsao G, Navasa M, Piddock LJ, Planas R, Bernard B, Inadomi JM. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol. 2000;32:142–53.

    PubMed  CAS  Article  Google Scholar 

  52. Nguyen-Khac E, Cadranel JF, Thevenot T, Nousbaum JB. Review article: the utility of reagent strips in the diagnosis of infected ascites in cirrhotic patients. Aliment Pharmacol Ther. 2008;28:282–8.

    PubMed  CAS  Article  Google Scholar 

  53. Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, Castells L, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999;341:403–9.

    PubMed  CAS  Article  Google Scholar 

  54. Han G, Qi X, He C, Yin Z, Wang J, Xia J, Yang Z, et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis. J Hepatol. 2011;54:78–88.

    PubMed  Article  Google Scholar 

  55. Rautou PE, Angermayr B, Garcia-Pagan JC, Moucari R, Peck-Radosavljevic M, Raffa S, Bernuau J, et al. Pregnancy in women with known and treated Budd-Chiari syndrome: maternal and fetal outcomes. J Hepatol. 2009;51:47–54.

    PubMed  Article  Google Scholar 

  56. Garcia-Pagan JC, Heydtmann M, Raffa S, Plessier A, Murad S, Fabris F, Vizzini G, et al. TIPS for Budd-Chiari syndrome: long-term results and prognostics factors in 124 patients. Gastroenterology. 2008;135:808–15.

    PubMed  Article  Google Scholar 

  57. Arroyo V, Gines P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology. 1996;23:164–76.

    PubMed  CAS  Article  Google Scholar 

  58. Salerno F, Gerbes A, Gines P, Wong F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut. 2007;56:1310–8.

    PubMed  CAS  Google Scholar 

  59. Krag A, Bendtsen F, Henriksen JH, Moller S. Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites. Gut. 2010;59:105–10.

    PubMed  CAS  Article  Google Scholar 

  60. Rajekar H, Chawla Y. Terlipressin in hepatorenal syndrome: evidence for present indications. J Gastroenterol Hepatol. 2011;26 Suppl 1:109–14.

    PubMed  Article  Google Scholar 

  61. Sagi SV, Mittal S, Kasturi KS, Sood GK. Terlipressin therapy for reversal of type 1 hepatorenal syndrome: a meta-analysis of randomized controlled trials. J Gastroenterol Hepatol. 2010;25:880–5.

    PubMed  CAS  Article  Google Scholar 

  62. Gluud LL, Christensen K, Christensen E, Krag A. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome. Hepatology. 2010;51:576–84.

    PubMed  CAS  Article  Google Scholar 

  63. Gerbes AL, Gulberg V, Sauerbruch T, Wiest R, Appenrodt B, Bahr MJ, Dollinger MM, et al. (German S 3-Guideline “ascites, spontaneous bacterial peritonitis, hepatorenal syndrome”). Z Gastroenterol. 2011;49:749–79.

    PubMed  CAS  Article  Google Scholar 

  64. Sanyal AJ, Boyer T, Garcia-Tsao G, Regenstein F, Rossaro L, Appenrodt B, Blei A, et al. A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome. Gastroenterology. 2008;134:1360–8.

    PubMed  CAS  Article  Google Scholar 

  65. Neri S, Pulvirenti D, Malaguarnera M, Cosimo BM, Bertino G, Ignaccolo L, Siringo S, et al. Terlipressin and albumin in patients with cirrhosis and type I hepatorenal syndrome. Dig Dis Sci. 2008;53:830–5.

    PubMed  CAS  Article  Google Scholar 

  66. Martin-Llahi M, Pepin MN, Guevara M, Diaz F, Torre A, Monescillo A, Soriano G, et al. Terlipressin and albumin vs. albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology. 2008;134:1352–9.

    PubMed  CAS  Article  Google Scholar 

  67. Piano S, Morando F, Fasolato S, Cavallin M, Boscato N, Boccagni P, Zanus G, et al. Continuous recurrence of type 1 hepatorenal syndrome and long-term treatment with terlipressin and albumin: a new exception to MELD score in the allocation system to liver transplantation? J Hepatol. 2011;55:491–6.

    PubMed  Article  Google Scholar 

  68. Boyer TD, Sanyal AJ, Garcia-Tsao G, Blei A, Carl D, Bexon AS, Teuber P. Predictors of response to terlipressin plus albumin in hepatorenal syndrome (HRS) type 1: relationship of serum creatinine to hemodynamics. J Hepatol. 2011;55:315–21.

    PubMed  CAS  Article  Google Scholar 

  69. Salerno F, Cazzaniga M, Merli M, Spinzi G, Saibeni S, Salmi A, Fagiuoli S, et al. Diagnosis, treatment and survival of patients with hepatorenal syndrome: a survey on daily medical practice. J Hepatol. 2011;55(6):124–8.

    Article  CAS  Google Scholar 

  70. Gerbes AL, Huber E, Gulberg V. Terlipressin for hepatorenal syndrome: continuous infusion as an alternative to i.v. bolus administration. Gastroenterology. 2009;137: 1179–81.

    PubMed  Article  Google Scholar 

  71. Sharma P, Kumar A, Shrama BC, Sarin SK. An open label, pilot, randomized controlled trial of noradrenaline versus terlipressin in the treatment of type 1 hepatorenal syndrome and predictors of response. Am J Gastroenterol. 2008;103:1689–97.

    PubMed  CAS  Article  Google Scholar 

  72. Wong F, Pantea L, Sniderman K. Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology. 2004;40:55–64.

    PubMed  CAS  Article  Google Scholar 

  73. Angeli P, Volpin R, Gerunda G, Craighero R, Roner P, Merenda R, Amodio P, et al. Reversal of type 1 hepatorenal syndrome with the administration of midodrine and octreotide. Hepatology. 1999;29:1690–7.

    PubMed  CAS  Article  Google Scholar 

  74. Ortega R, Gines P, Uriz J, Cardenas A, Calahorra B, De Las Heras D, Guevara M, et al. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology. 2002;36:941–8.

    PubMed  CAS  Google Scholar 

  75. Brensing KA, Textor J, Perz J, Schiedermaier P, Raab P, Strunk H, Klehr HU, et al. Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study. Gut. 2000;47:288–95.

    Google Scholar 

  76. Guevara M, Gines P, Bandi JC, Gilabert R, Sort P, Jimenez W, Garcia-Pagan JC, et al. Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: effects on renal function and vasoactive systems (see comments). Hepatology. 1998;28:416–22.

    PubMed  CAS  Article  Google Scholar 

  77. Rossle M, Gerbes AL. TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update. Gut. 2010;59:988–1000.

    PubMed  Article  Google Scholar 

  78. Rifai K, Kribben A, Gerken G, Haag S, Herget-Rosenthal S, Treichel U, Betz C, et al. Extracorporeal liver support by fractionated plasma separation and adsorption (Prometheus) in patients with acute-on-chronic liver failure (HELIOS study): a prospective randomized controlled multicenter study. J Hepatol. 2010;52:6A.

    Article  Google Scholar 

  79. Banares R, Nevens F, Larsen FS, Jalan R, Albillos A, Dollinger M. Relief Study Group. Extracorporeal liver support with the molecular absorbent recirculating system (MARS) in patients with acute-on-chronic liver failure (AOCLF). The RELIEF trial. J Hepatol. 2010;52:1184A.

    Google Scholar 

  80. Charlton MR, Wall WJ, Ojo AO, Gines P, Textor S, Shihab FS, Marotta P, et al. Report of the first international liver transplantation society expert panel consensus conference on renal insufficiency in liver transplantation. Liver Transpl. 2009;15:S1–34.

    Google Scholar 

  81. Fernandez J, Navasa M, Planas R, Montoliu S, Monfort D, Soriano G, Vila C, et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology. 2007;133:818–24.

    PubMed  CAS  Article  Google Scholar 

  82. Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O. Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial. Gastroenterology. 2000;119:1637–48.

    PubMed  CAS  Article  Google Scholar 

  83. Lebrec D, Thabut D, Oberti F, Perarnau JM, Condat B, Barraud H, Saliba F, et al. Pentoxifylline does not decrease short-term mortality but does reduce complications in patients with advanced cirrhosis. Gastroenterology. 2010;138:1755–62.

    PubMed  CAS  Article  Google Scholar 

  84. Ogren M, Bergqvist D, Bjorck M, Acosta S, Eriksson H, Sternby NH. Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J Gastroenterol. 2006;12:2115–9.

    PubMed  Google Scholar 

  85. Ogren M, Bergqvist D, Bjorck M, Acosta S, Sternby NH. High incidence of concomitant venous thromboembolism in patients with portal vein thrombosis: a population study based on 23,796 consecutive autopsies. J Thromb Haemost. 2007;5:198–200.

    PubMed  CAS  Article  Google Scholar 

  86. Sarin SK, Sollano JD, Chawla YK, Amarapurkar D, Hamid S, Hashizume M, Jafri W, et al. Consensus on extra-hepatic portal vein obstruction. Liver Int. 2006;26:512–19.

    PubMed  Article  Google Scholar 

  87. Janssen HL, Garcia-Pagan JC, Elias E, Mentha G, Hadengue A, Valla DC. Budd-Chiari syndrome: a review by an expert panel. J. Hepatol. 2003;38:364–71.

    PubMed  Article  Google Scholar 

  88. de Franchis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J. Hepatol. 2010;53:762–8.

    PubMed  Article  Google Scholar 

  89. Rajani R, Melin T, Bjornsson E, Broome U, Sangfelt P, Danielsson A, Gustavsson A, et al. Budd-Chiari syndrome in Sweden: epidemiology, clinical characteristics and survival—an 18-year experience. Liver Int. 2009;29:253–9.

    PubMed  Article  Google Scholar 

  90. Smalberg JH, Koehler E, Darwish Murad S, Plessier A, Seijo S, Trebicka J, Primignani M, et al. The JAK2 46/1 haplotype in Budd-Chiari syndrome and portal vein thrombosis. Blood. 2011;117:3968–73.

    PubMed  CAS  Article  Google Scholar 

  91. Xavier SG, Gadelha T, Pimenta G, Eugenio AM, Ribeiro DD, Gomes FM, Bonamino M, et al. JAK2V617F mutation in patients with splanchnic vein thrombosis. Dig Dis Sci. 2010;55:1770–7.

    PubMed  CAS  Article  Google Scholar 

  92. Tondeur S, Boutruche S, Biron-Andreani C, Schved JF. Prevalence of the JAK2 V617F mutation associated with splanchnic vein thrombosis. A 10-year retrospective study. Thromb Haemost. 2009;101:787–9.

    PubMed  CAS  Google Scholar 

  93. Colaizzo D, Amitrano L, Tiscia GL, Scenna G, Grandone E, Guardascione MA, Brancaccio V, et al. The JAK2 V617F mutation frequently occurs in patients with portal and mesenteric venous thrombosis. J Thromb Haemost. 2007;5:55–61.

    PubMed  CAS  Article  Google Scholar 

  94. Carreras E, Bertz H, Arcese W, Vernant JP, Tomas JF, Hagglund H, Bandini G, et al. Incidence and outcome of hepatic veno-occlusive disease after blood or marrow transplantation: a prospective cohort study of the European group for blood and marrow transplantation. European group for blood and marrow transplantation chronic leukemia working party. Blood. 1998;92:3599–604.

    PubMed  CAS  Google Scholar 

  95. Deleve LD, Valla DC, Garcia-Tsao G. Vascular disorders of the liver. Hepatology. 2009;49:1729–64.

    PubMed  CAS  Article  Google Scholar 

  96. Tsochatzis EA, Senzolo M, Germani G, Gatt A, Burroughs AK. Systematic review: portal vein thrombosis in cirrhosis. Aliment Pharmacol Ther. 2010;31:366–74.

    PubMed  CAS  Article  Google Scholar 

  97. Hoekstra J, Janssen HL. Vascular liver disorders (I): diagnosis, treatment and prognosis of Budd-Chiari syndrome. Neth J Med. 2008;66:334–9.

    PubMed  CAS  Google Scholar 

  98. Hoekstra J, Janssen HL. Vascular liver disorders (II): portal vein thrombosis. Neth J Med. 2009;67:46–53.

    PubMed  CAS  Google Scholar 

  99. Crawford JM. Vascular disorders of the liver. Clin Liver Dis. 2010;14:635–50.

    PubMed  Article  Google Scholar 

  100. Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, Beghetti M, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. 2009;30:2493–537.

    PubMed  Article  Google Scholar 

  101. Rodriguez-Roisin R, Krowka MJ, Herve P, Fallon MB. Pulmonary-Hepatic vascular disorders (PHD). Eur Respir J. 2004;24:861–80.

    PubMed  CAS  Article  Google Scholar 

  102. Hadengue A, Benhayoun MK, Lebrec D, Benhamou JP. Pulmonary hypertension complicating portal hypertension: prevalence and relation to splanchnic hemodynamics. Gastroenterology. 1991;100:520–8.

    PubMed  CAS  Google Scholar 

  103. Colle IO, Moreau R, Godinho E, Belghiti J, Ettori F, Cohen-Solal A, Mal H, et al. Diagnosis of portopulmonary hypertension in candidates for liver transplantation: a prospective study. Hepatology. 2003;37:401–9.

    PubMed  Article  Google Scholar 

  104. Benjaminov FS, Prentice M, Sniderman KW, Siu S, Liu P, Wong F. Portopulmonary hypertension in decompensated cirrhosis with refractory ascites. Gut. 2003;52:1355–62.

    PubMed  CAS  Article  Google Scholar 

  105. Ramsay MA, Simpson BR, Nguyen AT, Ramsay KJ, East C, Klintmalm GB. Severe pulmonary hypertension in liver transplant candidates. Liver Transpl Surg. 1997;3:494–500.

    PubMed  CAS  Article  Google Scholar 

  106. Taura P, Garcia-Valdecasas JC, Beltran J, Izquierdo E, Navasa M, Sala-Blanch J, Mas A, et al. Moderate primary pulmonary hypertension in patients undergoing liver transplantation. Anesth Analg. 1996;83:675–80.

    PubMed  CAS  Google Scholar 

  107. Castro M, Krowka MJ, Schroeder DR, Beck KC, Plevak DJ, Rettke SR, Cortese DA, et al. Frequency and clinical implications of increased pulmonary artery pressures in liver transplant patients. Mayo Clin Proc. 1996;71:543–51.

    PubMed  CAS  Article  Google Scholar 

  108. Plevak D, Krowka M, Rettke S, Dunn W, Southorn P. Successful liver transplantation in patients with mild to moderate pulmonary hypertension. Transplant Proc. 1993;25:1840.

    PubMed  CAS  Google Scholar 

  109. Robalino BD, Moodie DS. Association between primary pulmonary hypertension and portal hypertension: analysis of its pathophysiology and clinical, laboratory and hemodynamic manifestations. J Am Coll Cardiol. 1991;17:492–8.

    PubMed  CAS  Article  Google Scholar 

  110. McLaughlin VV, Genthner DE, Panella MM, Hess DM, Rich S. Compassionate use of continuous prostacyclin in the management of secondary pulmonary hypertension: a case series. Ann Intern Med. 1999;130:740–3.

    PubMed  CAS  Article  Google Scholar 

  111. Krowka MJ, Frantz RP, McGoon MD, Severson C, Plevak DJ, Wiesner RH. Improvement in pulmonary hemodynamics during intravenous epoprostenol (prostacyclin): a study of 15 patients with moderate to severe portopulmonary hypertension. Hepatology. 1999;30:641–8.

    PubMed  CAS  Article  Google Scholar 

  112. Hoeper MM, Seyfarth HJ, Hoeffken G, Wirtz H, Spiekerkoetter E, Pletz MW, Welte T, et al. Experience with inhaled iloprost and bosentan in portopulmonary hypertension. Eur Respir J. 2007;30:1096–102.

    PubMed  CAS  Article  Google Scholar 

  113. Hoeper MM, Halank M, Marx C, Hoeffken G, Seyfarth HJ, Schauer J, Niedermeyer J, et al. Bosentan therapy for portopulmonary hypertension. Eur Respir J. 2005;25:502–8.

    PubMed  CAS  Article  Google Scholar 

  114. Tan HP, Markowitz JS, Montgomery RA, Merritt WT, Klein AS, Thuluvath PJ, Poordad FF, et al. Liver transplantation in patients with severe portopulmonary hypertension treated with preoperative chronic intravenous epoprostenol. Liver Transpl. 2001;7:745–9.

    Google Scholar 

  115. Kett DH, Acosta RC, Campos MA, Rodriguez MJ, Quartin AA, Schein RM. Recurrent portopulmonary hypertension after liver transplantation: management with epoprostenol and resolution after retransplantation. Liver Transpl. 2001;7:645–8.

    PubMed  CAS  Article  Google Scholar 

  116. Plotkin JS, Kuo PC, Rubin LJ, Gaine S, Howell CD, Laurin J, Njoku MJ, et al. Successful use of chronic epoprostenol as a bridge to liver transplantation in severe portopulmonary hypertension. Transplantation. 1998;65:457–9.

    PubMed  CAS  Article  Google Scholar 

  117. Ashfaq M, Chinnakotla S, Rogers L, Ausloos K, Saadeh S, Klintmalm GB, Ramsay M, et al. The impact of treatment of portopulmonary hypertension on survival following liver transplantation. Am J Transplant. 2007;7:1258–64.

    PubMed  CAS  Article  Google Scholar 

  118. Reichenberger F, Voswinckel R, Steveling E, Enke B, Kreckel A, Olschewski H, Grimminger F, et al. Sildenafil treatment for portopulmonary hypertension. Eur Respir J. 2006;28:563–7.

    PubMed  CAS  Article  Google Scholar 

  119. Kuntzen C, Gulberg V, Gerbes AL. Use of a mixed endothelin receptor antagonist in portopulmonary hypertension: a safe and effective therapy? Gastroenterology. 2005;128:164–8.

    PubMed  Article  Google Scholar 

  120. Cartin-Ceba R, Swanson K, Iyer V, Wiesner RH, Krowka MJ. Safety and efficacy of ambrisentan for the treatment of portopulmonary hypertension. Chest. 2011;139:109–14.

    PubMed  CAS  Article  Google Scholar 

  121. Provencher S, Herve P, Jais X, Lebrec D, Humbert M, Simonneau G, Sitbon O. Deleterious effects of beta-blockers on exercise capacity and hemodynamics in patients with portopulmonary hypertension. Gastroenterology. 2006;130:120–6.

    PubMed  CAS  Article  Google Scholar 

  122. Fallon MB, Krowka MJ, Brown RS, Trotter JF, Zacks S, Roberts KE, Shah VH, et al. Impact of hepatopulmonary syndrome on quality of life and survival in liver transplant candidates. Gastroenterology. 2008;135:1168–75.

    PubMed  Article  Google Scholar 

  123. Schenk P, Schoniger-Hekele M, Fuhrmann V, Madl C, Silberhumer G, Muller C. Prognostic significance of the hepatopulmonary syndrome in patients with cirrhosis. Gastroenterology. 2003;125:1042–52.

    PubMed  Article  Google Scholar 

  124. Swanson KL, Wiesner RH, Krowka MJ. Natural history of hepatopulmonary syndrome: impact of liver transplantation. Hepatology. 2005;41:1122–9.

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

A. Ferlitsch: Consultant for Pejcl Medizintechnik, Austria; Boston Scientifc: Travel expenses; Boston Scientific, Cook Medical, Ferring: Sponsoring of dedicated meetings.

V. Fuhrmann: Forschungsunterstützung von den Firmen Actelion, Air Liquide und Vivisol.

T. Reiberger: Roche (speaking/teaching, travel grant), MSD (speaking/teaching, research grant), Phenex Pharma (research grant), Gilead Sciences (research grant, travel grant), Janssen (research grant).

Rest of the authors declare that there are no actual or potential conflicts of interest in relation to this article.

Author information

Authors and Affiliations

  1. Klinische Abteilung für Gastroenterologie und Hepatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090, Vienna, Austria

    Markus Peck-Radosavljevic MD, Arnulf Ferlitsch MD, Monika Ferlitsch MD, Valentin Fuhrmann MD, Berit Payer MD, Thomas Reiberger MD & Michael Trauner MD

  2. 2. Medizinische Abteilung, Landesklinikum St. Pölten, St. Pölten, Austria

    Bernhard Angermayr MD

  3. Abteilung Innere Medizin, Krankenhaus Oberndorf, bei Salzburg, Austria

    Christian Datz MD

  4. Krankenhaus St. Elisabeth, Vienna, Austria

    Michael Häfner MD

  5. 1. Medizinische Abteilung mit Gastroenterologie, Krankenhaus Hietzing, Vienna, Austria

    Ludwig Kramer MD & Gregor Ulbrich MD

  6. 4. Interne Abteilung, Krankenhaus St. Elisabeth, Linz, Austria

    Andreas Maieron MD

  7. Klinische Abteilung für Abteilung Gastroenterologie und Hepatologie, Medizinische Universität Graz, Graz, Austria

    Rudolf Stauber MD

  8. Universitätsklinik für Chirurgie, Medizinische Universität Wien, Vienna, Austria

    Rudolf Steininger MD

  9. Klinische Abteilung für Radiologie und Nuklearmedizin, Krankenhaus Barmherzige Brüder Wien, Vienna, Austria

    Siegfried Thurnher MD

  10. Universitätsklinik für Innere Medizin (Gastroenterologie und Hepatologie), Medizinische Universität Innsbruck, Innsbruck, Austria

    Wolfgang Vogel MD, Heinz Zoller MD & Ivo Graziadei MD

Authors
  1. Markus Peck-Radosavljevic MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bernhard Angermayr MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christian Datz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arnulf Ferlitsch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Monika Ferlitsch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Valentin Fuhrmann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Häfner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ludwig Kramer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Andreas Maieron MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Berit Payer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Thomas Reiberger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Rudolf Stauber MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Rudolf Steininger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Michael Trauner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Siegfried Thurnher MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Gregor Ulbrich MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Wolfgang Vogel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Heinz Zoller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Ivo Graziadei MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the Austrian Society of Gastroenterology and Hepatology (ÖGGH)

Corresponding author

Correspondence to Markus Peck-Radosavljevic MD.

Additional information

For the Austrian Society of Gastroenterology and Hepatology (ÖGGH)

Appendix

Appendix

Participants “Billroth II”, 2. ÖGGH-Consensus Conference “Portal Hypertension”, Palais Clam Gallas, Vienna 011011

Dr. Bernhard Angermayr Landesklinikum St. Pölten, 2. Medizinische Abteilung
Dr. Eva Brownstone KA Rudolfstiftung, 4. Medizinische Abteilung
Theresa Bucsics Univ.-Klinik für Innere Medizin III, AKH
Prim. Dr. Christian Datz Krankenhaus Oberndorf, Abteilung Innere Medizin
Dr. Arnulf Ferlitsch Univ.-Klinik für Innere Medizin III, AKH
PD Dr. Valentin Fuhrmann Univ.-Klinik für Innere Medizin III, AKH
Univ.-Prof. Dr. Ivo Graziadei Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Innsbruck
Dr. Evelyn Grilnberger Otto Wagner Spital
Prim. Dr. Michael Häfner KH St. Elisabeth, Interne Abteilung
Dr. Birgit Heinisch Univ.-Klinik für Innere Medizin III, AKH
Dr. Sadia Hoppe KH Hietzing, I. Medizinische Abteilung
Dr. Thomas Horvatits Univ.-Klinik für Innere Medizin III, AKH
Prim. Dr. Andreas Kirchgatterer V. Interne Abteilung, Klinikum Wels
Prim. Dr. Peter Knoflach Klinikum Wels-Grieskirchen, Abteilung für Innere Medizin I
Dr. Andreas Kopecky Thermenklinikum Baden, Interne Abteilung
Dr. Peter Kotlan Ordination Markt Priestling
Prof. Dr. Ludwig Kramer Krankenhaus Hietzing, 1. Medizinische Abteilung mit Gastroenterologie
Dr. Anna Kreil Otto Wagner Spital
Waltraud Leiss Univ.-Klinik für Innere Medizin III, AKH
Dr. Simone Luszczak Landesklinikum St. Pölten, 2. Medizinische Abteilung
Prim. Dr. Christian Madl KA Rudolfstiftung, 4. Medizinische Abteilung
Dr. Andreas Maieron Krankenhaus St. Elisabeth Linz, 4. Interne Abteilung
Dr. Ilona Marszalek Ordination Dr. Biowski-Frotz, Wien
Prof. Dr. Christian Müller Univ.-Klinik für Innere Medizin III, AKH
Dr. Roland Nömeyer Klinikum Wels-Grieskirchen, Abteilung für Innere Medizin I
Dr. Julia Palkovits Krankenhaus Hietzing, 1. Medizinische Abteilung mit Gastroenterologie
Dr. Berit Anna Payer Univ.-Klinik für Innere Medizin III, AKH
Prof. Dr. Markus Peck-Radosavljevic Univ.-Klinik für Innere Medizin III, AKH
Prim. Dr. Johann Pidlich Thermenklinikum Baden, Interne Abteilung
Dr. Csilla Putz-Bankuti Universitätsklinik für Innere Medizin, LKH Graz
Dr. Thomas Reiberger Univ.-Klinik für Innere Medizin III, AKH
Dr. Birgit Reinhart  
Dr. Karoline Reinhart Univ.-Klinik für Innere Medizin III, AKH
Dr. Petra Salzl Univ.-Klinik für Innere Medizin III, AKH
Dr. Monika Schmid Univ.-Klinik für Innere Medizin III, AKH
Dr. Christiane Schrutka KA Rudolfstiftung, 4. Medizinische Abteilung
Dr. Bernhard Stadler Klinikum Wels-Grieskirchen
Prof. Dr. Rudolf Stauber Medizinische Universität Graz, Abteilung Gastroenterologie und Hepatologie
Dr. Philipp Steininger Krankenhaus St. Elisabeth Wien, Interne Abteilung
Prof. Dr. Rudolf Steininger Universitätsklinik für Chirurgie, Medizinische Uni Wien
Prim. Dr. Siegfried Thurnher Krankenhaus Barmherzige Brüder Wien, Radiologie und Nuklearmedizin
Prof. Dr. Michael Trauner Univ.-Klinik für Innere Medizin III, AKH
Prof. Dr. Barbara Tribl Univ.-Klinik für Innere Medizin III, AKH
Dr. Gregor Ulbrich Krankenhaus Hietzing, 1. Medizinische Abteilung mit Gastroenterologie
Prim. Prof. Dr. Wolfgang Vogel Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Innsbruck
Dr. Martina Wichlas KH Barmherzige Brüder, II. Medizinische Abteilung
Dr. Afrodite Zendeli KH Barmherzige Brüder, II. Medizinische Abteilung
Prof. Dr. Heinz Zoller Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Innsbruck

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Peck-Radosavljevic, M., Angermayr, B., Datz, C. et al. Austrian consensus on the definition and treatment of portal hypertension and its complications (Billroth II). Wien Klin Wochenschr 125, 200–219 (2013). https://doi.org/10.1007/s00508-013-0337-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-013-0337-z

Keywords

  • Ascites
  • Variceal bleeding
  • TIPS
  • Hepatorenal syndrome
  • Hepatopulmonary syndrome
  • Portopulmonary hypertension
  • Budd-Chiari Syndrome
  • Somatostatin
  • Terlipressin
  • Carvedilo

Schlüsselwörter

  • Aszites
  • Varizenblutung
  • TIPS
  • Hepatorenales Syndrom
  • Hepatopulmonales Syndrom
  • Portopulmonale Hypertension
  • Budd-Chiari Syndrom
  • Somatostatin
  • Terlipressin
  • Carvedilol