Portal Hypertension Treatment

Unfortunately, most causes of portal hypertension cannot be treated.  For example, cirrhosis is irreversible.  Instead, treatment focuses on preventing or managing the complications, especially the bleeding from the swollen, enlarged veins (varices).

Determining your Treatment Options

Endoscopy, radiology procedures, surgery, medications and diet all have a role in treating or preventing the complications. Other treatment depends on your age, overall health, personal preferences, how well your liver is functioning and severity of symptoms. Your team of doctors will take all of that into account with the treatments they recommend. 

Portal Hypertension Treatment in Burlington, VT

Portal hypertension treatment options at Fletcher Allen include:

  • Endoscopy
    • Sclerotherapy
    • Banding
  • Liver Transplant
  • Surgical Shunts
    • Transjugular Intrahepatic Portosystemic Shunt (TIPS)
    • Distal splenorenal shunt (DSRS)
  • Medications
  • Devascularization
  • Paracentesis

Endoscopy

Endoscopic therapy is usually the first line of treatment for variceal bleeding and consists of either sclerotherapy or banding:

  • Sclerotherapy is a procedure in which a blood-clotting solution is injected into the bleeding varices to stop bleeding.  Sclerotherapy is occasionally used when banding cannot be performed.
  • Banding is a procedure in which a gastroenterologist blocks off the blood vessel using rubber bands to stop bleeding.

Liver Transplant

Liver transplant may be an option if your liver disease is end-stage. During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver from a donor. Most transplanted livers come from deceased donors, but a small number come from living donors who donate a part of their livers.

Surgical Shunts

Shunt surgeries are designed to redirect the flow of blood or abdominal fluid through other areas of the body:

  • Transjugular Intrahepatic Portosystemic Shunt (TIPS) places a tubular device (called stent) in the middle of the liver. The stent connects the hepatic vein with the portal vein, which reroutes blood flow in the liver and helps relieve pressure in abnormal veins.
  • Distal Splenorenal Shunt (DSRS) connects the vein from your spleen to the vein from the left kidney in order to reduce pressure in the varices and control bleeding.

Medications

  • Nonselective beta blockers (nadolol or propranolol) may be prescribed to reduce the pressure in varices and lower the risk of bleeding.
  • Lactulose can help treat confusion and other mental changes caused by abnormal functioning of the brain that happen with severe liver disease (encephalopathy).
  • Diuretics are prescribed for fluid buildup in the abdomen (ascites).

Devascularization

This surgical procedure removes the bleeding varices. This procedure is done when a TIPS or a surgical shunt is not possible or is unsuccessful in controlling the bleeding.

Paracentesis

This procedure directly removes the fluid in the abdomen (ascites). Typically, the results are temporary and the procedure will need to be repeated as needed.

Find a Fletcher Allen physician or call 802-847-8865.