Hipertensión portal no cirrótica

  1. Carmen Alonso Martín 1
  2. Cristina Martínez Cuevas 1
  3. Beatriz Madrigal Rubiales 2
  4. Elena Villacastin Ruiz 3
  5. Gloria Sánchez Antolín 1
  1. 1 Servicios de Aparato Digestivo, Unidad de Trasplante Hepático, Valladolid, España
  2. 2 Servicios de Anatomía Patológica, Unidad de Trasplante Hepático, Valladolid, España
  3. 3 Servicios de Unidad de Radiología Intervencionista, Hospital Universitario Río Hortega, Valladolid, España
Show affiliations +
Journal:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Year of publication: 2024

Issue Title: Enfermedades del aparato digestivo (XII) Patología peritoneal, portal y mesentérica

Series: 14

Issue: 12

Pages: 660-671

Type: Article

DOI: 10.1016/J.MED.2024.06.003 DIALNET GOOGLE SCHOLAR

More publications in: Medicine: Programa de Formación Médica Continuada Acreditado

Abstract

Portal hypertension of non-cirrhotic origin encompasses a heterogeneous group of diseases of intrahepatic and extrahepatic etiology. In most cases there is a vascular lesion, which are classified as pre-hepatic, hepatic, and post-hepatic according to the area where the blood flow obstruction occurs. Despite its low prevalence, they can cause significant morbidity and mortality in patients, who are generally young. Therefore, it is essential for the clinician to have a high degree of suspicion and start treatment as soon as possible. In regard to its diagnosis, Doppler ultrasound and computed tomography angiography are the tests with the greatest yield. Measuring portal pressures and a liver biopsy may be necessary depending on the context. Treatment will depend on the disease's etiology. Treating the underlying cause when known, suspending hepatotoxic drugs, and starting anticoagulation early will be the basis for most treatment. Endovascular therapies are becoming increasingly important and liver transplantation may be an option in cases in which liver failure is established or when complications of portal hypertension have been refractory to other treatments.

Bibliographic References

  • 1. C. Ripoll et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology. (2007)
  • 2. R. Khanna et al. Non-cirrhotic portal hypertension – Diagnosis and management. J Hepatol. (2014)
  • 3. F.R. Rosendaal. Venous thrombosis: A multicausal disease. Lancet. (1999)
  • 4. R. De Franchis. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. (2005)
  • 5. Y.K. Chawla et al. Portal vein thrombosis. J Clin Exp Hepatol. (2015)
  • 6. J. Turnes et al. Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol Hepatol. (2008)
  • 7. R.K. Dhiman et al. Portal cavernoma cholangiopathy: consensus statement of a working party of the Indian national association for study of the liver. J Clin Exp Hepatol. (2014)
  • 8. B. Condat et al. Current outcome of portal vein thrombosis in adults: Risk and benefit of anticoagulant therapy. Gastroenterology. (2001)
  • 9. R. de Franchis et al. Baveno VII - Renewing consensus in portal hypertension. J Hepatol. (2022)
  • 10. C. Francoz et al. Portal vein thrombosis, cirrhosis, and liver transplantation. J Hepatol. (2012)
  • 11. L. Elkrief et al. Management of splanchnic vein thrombosis. JHEP Reports [Internet]. (2023)
  • 12. G. Mentha et al. Liver transplantation for Budd-Chiari syndrome: A European study on 248 patients from 51 centres. J Hepatol. (2006)
  • 13. A. Mukund et al. Anatomic recanalization of hepatic vein and inferior vena cava versus direct intrahepatic portosystemic shunt creation in Budd-Chiari Syndrome: overall outcome and midterm transplant-free survival. J Vasc Interv Radiol. (2018)
  • 14. J.A. Coppell et al. Hepatic veno-occlusive disease following stem cell transplantation: incidence, clinical course, and outcome. Biol Blood Marrow Transplant. (2010)
  • 15. D.C. Valla et al. Sinusoidal obstruction syndrome. Clin Res Hepatol Gastroenterol. (2016)
  • 16. L. Rubbia-Brandt. Sinusoidal obstruction syndrome. Clin Liver Dis. (2010)
  • 17. M.N. Bodge et al. Preparative regimen dosing for hematopoietic stem cell transplantation in patients with chronic hepatic impairment: analysis of the literature and recommendations. Biol Blood Marrow Transplant. (2014)
  • 18. P.G. Richardson et al. Phase 3 trial of defibrotide for the treatment of severe veno-occlusive disease and multi-organ failure. Blood. (2016)
  • 19. J.C. García-Pagán et al. Hipertensión portal no cirrótica. Guía de práctica clínica de la EASL: Enfermedades vasculares hepáticas. J Hepatol.
  • 20. D.C. Valla et al. Spectrum of portal vein thrombosis in the West. J Gastroenterol Hepatol. (2002)
  • 21. R. Rajani et al. The epidemiology and clinical features of portal vein thrombosis: a multicentre study. Aliment Pharmacol Ther. (2010)
  • 22. M. Primignani et al. Risk factors for thrombophilia in extrahepatic portal vein obstruction. Hepatology. (2005)
  • 23. M.H. Denninger et al. Cause of portal or hepatic venous thrombosis in adults: The role of multiple concurrent factors. Hepatology. (2000)
  • 24. A. Plessier et al. European network for vascular disorders of the liver (EN-Vie). Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology. (2010)
  • 25. C. Noronha Ferreira et al. Natural history and management of esophagogastric varices in chronic noncirrhotic, nontumoral portal vein thrombosis. Hepatology. (2016)
  • 26. B. Mínguez et al. Noncirrhotic portal vein thrombosis exhibits neuropsychological and MR changes consistent with minimal hepatic encephalopathy. Hepatology. (2006)
  • 27. E. Llop et al. Portal cholangiopathy: radiological classification and natural history. Gut. (2011)
Data source: Dialnet