Portal hypertension is a medical condition in which the portal vein, a large vein that allows blood to flow into the liver from other organs in the body, increases in pressure. Treatment for portal hypertension involves managing the condition and preventing further complications, as, most of the time, the condition is untreatable. Different types of portal hypertension treatment are endoscopic therapy, medication, and dietary changes. Surgical and radiological procedures are additional types of portal hypertension treatment. Also, if any of the previous treatments methods are unsuccessful, then other treatment options include devascularization, liver transplant, and paracentesis.
The first levels of portal hypertension treatment are endoscopic therapy, medication, and dietary changes. Endoscopic therapy involves one of two procedures, banding or sclerotherapy. Banding involves the use of rubber bands to block blood supply, while sclerotherapy involves an injection of a solution that will cause varices to stop bleeding. Medication, like beta blockers, can help in reducing the pressure in the portal vein, as well as in reducing the possibility of bleeding. Dietary changes help to enable the liver to function appropriately and, although dietary changes vary from person to person, they include avoiding alcohol, avoiding any medications that might interfere with healing the liver, and following a low-sodium, sometimes reduced-protein, diet.
When the first levels of treatment fail to manage the condition or prevent it from getting worse, other portal hypertension treatment options include distal splenorenal shunt (DSRS) and transjugular intrahepatic portosystemic shunt (TIPS). Both procedures are decompression procedures, meaning that they help to reduce pressure in the portal vein. DSRS is a surgical procedure in which the vein from the spleen is connected to the vein from the left kidney. TIPS, on the other hand, is a radiological procedure where a stent, put in the middle of the liver, connects the portal vein to the hepatic vein. Before undergoing either of these procedures, the patient will need to have tests done, including blood tests, endoscopy, and an ultrasound.
Devascularization is another surgical procedure used to treat portal hypertension, but it is normally used when other options prove unsuccessful. In this procedure, the surgeon removes the varices that are bleeding. Liver transplant is a treatment option when the liver is too damaged and can no longer function properly and needs to be replaced. Lastly, another treatment option for portal hypertension is a procedure known as paracentesis. This procedure involves removing an accumulation of fluid that resides in the abdomen.