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NewYork-Presbyterian/Weill Cornell Medical Center - Center for Advanced Digestive Care

Portal Hypertension

Portal hypertension is a type of liver disease characterized by increased blood pressure in the portal vein - a major vein that transports blood from the stomach to the liver, large and small intestines, spleen, gallbladder, and pancreas. High blood pressure or hypertension in this vein is most often caused by cirrhosis of the liver (scarring of liver tissue). Other causes include blood clots in the vein and schistosomiasis - a parasitic infection common in Africa, sub-Saharan Africa, southern China, the Middle East, Southeast Asia, South America, and a few countries in the Caribbean.

Doctors in the Center for Advanced Digestive Care (CADC) at NewYork-Presbyterian/Weill Cornell Medical Center are leaders in the care of patients with all types of liver diseases, and have pioneered innovative treatments. The team includes all of the medical and surgical specialists required to care for patients with portal hypertension, offering comprehensive and personalized care customized to each patient's needs.

Symptoms of Portal Hypertension

Portal hypertension can cause a life-threatening condition known as esophageal varices, where blood vessels in the esophagus (and sometimes in the stomach or rectum) become enlarged and can rupture, causing internal bleeding. Patients with varices often have black, tarry or bloody stools. They also may vomit blood.

Another condition caused by portal hypertension is ascites formation, when fluid accumulates in the abdomen. Patients with ascites may have abdominal swelling and pain, which can lead to loss of appetite from the swollen abdomen pressing on the stomach and shortness of breath from the swollen abdomen pressing on the lungs. In some cases, patients with ascites also develop swelling in their ankles.

A third condition caused by portal hypertension is hepatic encephalopathy, in which the damaged liver can no longer successfully remove toxins such as ammonia from the blood. These toxins travel to the brain and impair the function of brain cells. Patients with hepatic encephalopathy generally become forgetful or easily confused. In its most severe form, hepatic encephalopathy can cause significant lethargy or even coma.

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Portal Hypertension Diagnosis

If portal hypertension is suspected, the CADC's liver experts may perform upper endoscopy and/or ultrasound to make a diagnosis.

  • During upper endoscopy, the doctor inserts an endoscope - a narrow, flexible tube equipped with a tiny light and camera - into the mouth, through the esophagus, and into the stomach. The patient receives sedation to ensure comfort during the procedure. The physician can see images of the digestive tract and may also take a tissue sample for analysis (biopsy).
  • During ultrasound, sound waves are used to produce an image of blood vessels and internal organs and assess blood flow through the veins.

Treatment of Portal Hypertension

Medication

CADC doctors may prescribe medication to treat portal hypertension. Physicians may employ nonselective beta blockers - medications for hypertension which reduce blood pressure - to prevent bleeding from esophageal varices. They may prescribe diuretic pills to reduce fluid due to ascites. They may also prescribe an antibiotic and/or lactulose, a type of laxative, which help reduce the confusion and other mental changes caused by hepatic encephalopathy.

Other procedures that CADC physicians use to treat portal hypertension include banding or sclerotherapy.

Procedures

  • With banding, a gastroenterologist uses rubber bands to tie off varices. This reduces blood flow and pressure and the likelihood that the varices will rupture.
  • With sclerotherapy, physicians inject a liquid into the varices, which creates scar tissue. This treatment does not reduce pressure in the varices, but it does create a stronger protective "covering" to contain blood. Sclerotherapy is only done if banding cannot be performed.
  • CADC doctors sometimes treat severe portal hypertension with a procedure known as "transjugular intrahepatic portosystemic shunt," or TIPS. Before undergoing TIPS, patients have a number of tests to assess the function of their liver, heart, and kidney and to help determine the extent and severity of the portal hypertension. These tests may include echocardiography (the use of ultrasound to evaluate heart function), endoscopy, blood tests, and angiography. TIPS is typically used in patients where neither banding nor sclerotherapy can stop bleeding from varices or and when diuretic medication cannot control ascites fluid.