Portal hypertension is difficult to treat or cure. For that reason, your doctor will focus on preventing and managing complications and trying to reduce the pressure in your portal vein.
The main complication of portal hypertension is bleeding from the varices, and many of the treatment options aim to manage that bleeding.
Treatment options to manage portal hypertension and its complications:
Once we confirm that the portal hypertension is causing the varicose veins, you may begin drug therapy. The medications aim to reduce the blood flowing into the portal as well as reducing the pressure.
Medications used to treat portal hypertension include:
Beta blockers can be used to decrease portal pressure, although there are unpleasant side effects. However, if you have cirrhosis but no varices, beta blockers cannot be used to prevent varices from developing. Studies have shown that the side effects of the medication outweigh the possible benefits.
Vasopressin decreases the splanchnic blood flow (blood flow in the gastrointestinal region).
Antibiotics may be prescribed for a short term if you have cirrhosis and acute hemorrhage. The antibiotics may reduce the likelihood of re-bleeding.
An endoscopy can treat gastrointestinal hemorrhage. There are a number of endoscopic treatments for this purpose:
Banding: This is the preferred method to manage variceal hemorrhage. During an endoscopy, your doctor places small elastic rings over the vein. The rings block the blood supply to each varix. You will undergo the initial banding session, and then return for subsequent sessions in order to completely obliterate the varices.
Sclerotherapy: During an endoscopy, we inject sclerosant, a chemical irritant, into and around the varices in order to obliterate the vein. After your initial sclerotherapy session, you will need subsequent sessions to obliterate the varices.
Balloon tamponade: This is done to control variceal bleeding through compressing the vein. We inflate a small balloon within your stomach or esophagus to apply pressure to the bleeding veins. This compresses and stops the bleeding. This is a complex procedure that should only be performed by experienced physicians, like the gastroenterologists at Johns Hopkins.
Shunting is another method of controlling acute bleeding. If you have had recurrent bleeding despite medical or endoscopic treatment, you may require either of the two methods of shunting:
Nonsurgical transjugular intrahepatic portal systemic shunt (TIPSS): This procedure should only be performed by a doctor with a high level of expertise and experience. Your doctor will access the hepatic vein through the jugular vein, and pass a needle through the liver into the portal vein. The vein is then dilated and a stent is put in place to keep the vein open.
Surgical shunts: This is done to reduce the pressure in the portal vein, to maintain regular blood flow around the liver, and to reduce (or not worsen) hepatic encephalopathy.
Mechanism of ascites in portal hypertension; S=stomach; C=colon; I=intestine. (Click to Enlarge)
Liver transplantation is the only effective treatment for end-stage liver disease. Liver transplantation means your diseased liver is replaced with a healthy one. This option offers the highest survival rate and chance of complete rehabilitation.
Challenges include a scarcity of liver donors, your body rejecting the new liver and the great expense involved. The surgery is long and complex, requiring the removal and replacement of your body's largest solid organ.
Your doctor will discuss with you whether you are a candidate for liver transplantation, and what steps you must take to be placed on the waiting list for a new liver.