Portal hypertension.

PURPOSE OF REVIEW: Portal hypertension is the most common complication of cirrhosis accounting for significant morbidity and mortality mainly because of variceal hemorrhage, ascites, bacterial infections, hepatic encephalopathy, and hepatorenal syndrome. Advances in the diagnosis and management of portal hypertension over the last year are reviewed.

RECENT FINDINGS: The measurement of the hepatic venous pressure gradient provides important prognostic information in patients with portal hypertension. Noninvasive testing with transient elastography, capsule endoscopy, and computed tomography scanning for the diagnosis of esophageal varices is promising but more information is needed. Easily obtainable clinical data have been identified in patients with acute variceal bleeding that provides important information in determining initial response to therapy and prognosis. New therapies for patients with dilutional hyponatremia with vasopressin antagonists are promising and may improve the management of this condition. Terlipressin is the best medical therapy currently available for the management of hepatorenal syndrome as confirmed in recent studies. Patients with advanced liver disease benefit from the long-term administration of norfloxacin as it prevents the development of hepatorenal syndrome and improves survival.

SUMMARY: The ongoing advances in the diagnosis and management of patients with cirrhosis and portal hypertension will improve the high morbidity and mortality of the complications of cirrhosis