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Portal hypertensive syndrome: its importance and complications

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Book cover Portal Hypertension in the 21st Century

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Abstract

The management of portal hypertension continues to be a critical clinical problem for hepatologists and gastroenterologists. At one end of the spectrum of this clinical activity there is increasing interest in approaches to prevent the development of portal hypertension in chronic liver disease1. At the other end patients who are candidates for liver transplantation may develop all the complications of portal hypertension while waiting for an organ, as the current MELD (Model for End-stage Liver Disease) system has resulted in a higher priority for sicker patients. A rational approach, centered on evidence-based medicine, is needed to guide the practitioner through complex decisions.

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References

  1. Boyer TD. Pharmacological treatment of portal hypertension: past, present, and future. Hepatology. 2001;34:834–9.

    Article  PubMed  CAS  Google Scholar 

  2. Bosch J, Garcia-Pagan JC. Complications of cirrhosis. I. Portal hypertension. J Hepatol. 2000;32:141–56.

    Article  PubMed  CAS  Google Scholar 

  3. Popper H, Paronetto F, Schaffner F, Perez V. Studies on hepatic fibrosis. Lab Invest. 1961; 10:265–90.

    PubMed  CAS  Google Scholar 

  4. Bhatal PS, Grossman HJ. Reduction of the increased portal vascular resistance of the isolated cirrhotic perfused rat liver by vasodilators. J Hepatol. 1985;1:325–9.

    Article  Google Scholar 

  5. Iredale JP.Cirrhosis: new research provides a basis for rational and targeted treatments. Br Med J. 2003;327:143–7.

    Google Scholar 

  6. Bauer M, Zhang JX, Bauer I et al. ET-1 induced alterations of hepatic microcirculation: sinusoidal and extrasinusoidal sites of action. Am J Physiol. 1994;267:G143–9.

    PubMed  CAS  Google Scholar 

  7. Graupera M, Garcia-Pagan JC et al. 5-Lipoxygenase inhibition reduces intrahepatic vascular resistance of cirrhotic rat livers: a possible role of cysteinyl-leukotrienes. Gastroenterology. 2002;122:387–93.

    Article  PubMed  CAS  Google Scholar 

  8. Yokoyama Y, Xu H, Kresge N et al. Role of thromboxane A2 in early BDL-induced portal hypertension. Am J Physiol Gastrointest Liver Physiol. 2003;284:G453–60.

    PubMed  CAS  Google Scholar 

  9. Rockey De. Vascular mediators in the injured liver. Hepatology. 2003;37:4–12.

    Article  PubMed  CAS  Google Scholar 

  10. Sarela AI, Mihaimeed FM, Batten JJ ct al. Hepatic and splanchnic nitric oxide activity in patients with cirrhosis. Gut. 1999;44:749–53.

    Article  PubMed  CAS  Google Scholar 

  11. Shah V, Haddad FG, Garcia-Cardena G et al. Liver sinusoidal endothelial cells are responsible for nitric oxide modulation of resistance in the hepatic sinusoids. J Clin Invest. 1997; 100:2923–30.

    Article  PubMed  CAS  Google Scholar 

  12. Gupta TK, Toruner M, Chang MK et al. Endothelial dysfunction and decreased production of nitric oxide in the intrahepatic microcirculation of cirrhotic rats. Hepatology. 1998;28:926–31.

    Article  PubMed  CAS  Google Scholar 

  13. Hendrickson H, Chatterjee S, Cao S et al. Influence of caveolin on constitutively activated recombinant eNOS: insight into eNOS dysfunction in BDL rat liver. Am J Physiol Gastrointest Liver Physiol. 2003;285:G652–60.

    PubMed  CAS  Google Scholar 

  14. Wanless IR, Wong F, Blendis LM et al. Hepatic and portal vein thrombosis in cirrhosis: possible role in development of parenchymal extinction and portal hypertension. Hepatology. 1995;21:1238–47.

    PubMed  CAS  Google Scholar 

  15. Van de Casteele M, Omasta A, Janssens S et al. In vivo gene transfer of endothelial nitric oxide synthase decreases portal pressure in anaesthetized carbon tetrachloride cirrhotic rats. Gut. 2002;51:440–5.

    Article  PubMed  Google Scholar 

  16. Morales-Ruiz M, Cejudo-Martin P, Fernandez-Varo G et al. Transduction of the liver with activated Akt normalizes portal pressure in cirrhotic rats. Gastroenterology. 2003;125:522–31.

    Article  PubMed  CAS  Google Scholar 

  17. Fiorucci S, Antonelli E, Morelli O et al. NCX-1000, a NO-releasing derivative of ursodeoxycholic acid, selectively delivers NO to the liver and protects against development of portal hypertension. Proc Natl Acad Sci USA. 2001;98:8897–902.

    Article  PubMed  CAS  Google Scholar 

  18. Zafra C, Abraldes JG, Turnes J et al. Simvastin enhances hepatic nitric oxide production and decreases the hepatic vascular tone in patients with cirrhosis. Gastroenterology. 2004;126:749–55.

    Article  PubMed  CAS  Google Scholar 

  19. Garcia-Tsao G, Grozsmann RJ, Fisher RL et al. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985;5:419–24.

    Article  PubMed  CAS  Google Scholar 

  20. Viallet A, Marleau O, Huet M et al. Hemodynamic evaluation of patients with intrahepatic portal hypertension. Relationship between bleeding varices and the portohepatic gradient. Gastroenterology. 1975;69: 1297–300.

    PubMed  CAS  Google Scholar 

  21. Boyer TO. Changing clinical practice with measurements of portal pressure. Hepatology. 2004;39:283–5.

    Article  PubMed  Google Scholar 

  22. Sabba C, Ferraioli G, Buonamico P et al. A randomized study of propranolol on postprandial portal hypertension in cirrhotic patients. Gastroenterology. 1992;102:1009–16.

    PubMed  CAS  Google Scholar 

  23. Lee FY, Colombato LA, Albillos A et al. Administration of N omega-nitro-L-arginine ameliorates portal-systemic shunting in portal-hypertensive rats. Gastroenterology. 1993;105:1464–70.

    Article  PubMed  CAS  Google Scholar 

  24. Fernandez M, Vizzutti F, Garcia-Pagan JC et al. Anti-VEGF receptor-2 monoclonal antibody prevents portal-systemic collateral vessel formation in portal hypertensive mice. Gastroenterology. 2004;126:886–94.

    Article  PubMed  CAS  Google Scholar 

  25. Polio J, Groszmann RJ. Hemodynamic factors involved in the development and rupture of esophageal varices: a pathophysiologic approach to treatment. Semin Liver Dis. 1986;6:318–31.

    Article  PubMed  CAS  Google Scholar 

  26. Kawanaka H, Jones MK, Szabo IL et al. Activation of eNOS in rat portal hypertensive gastric mucosa is mediated by TNF-alpha via the PI 3-kinase-AKT signaling pathway. Hepatology. 2002;35:393–402.

    Article  PubMed  CAS  Google Scholar 

  27. Chesta J, Defilippi C, Defilippi C. Abnormalities in proximal small bowel motility in patients with cirrhosis. Hepatology. 1993;17:828–32.

    PubMed  CAS  Google Scholar 

  28. Wiest R, Das S, Cadelina G et al. Bacterial translocation in cirrhotic rats stimulates eNOS derived NO production and impairs mesenteric vascular contractibility. J Clin Invest. 1999;104:1223–33.

    Article  PubMed  CAS  Google Scholar 

  29. Cirera I, Bauer TM, Navasa M et al. Bacterial translocation of enteric organisms in patients with cirrhosis. J Hepatol. 2001;34:32–7.

    Article  PubMed  CAS  Google Scholar 

  30. Benoit IN, Barrowman JA, Harper SL et al. Role of humoral factors in the intestinal hyperemia associated with chronic portal hypertension. Am J Physiol. 1984;247:G486–93.

    PubMed  CAS  Google Scholar 

  31. Batkai S, Jarai Z, Wagner JA et al. Endocannabonoids acting as vascular CB1 receptors mediate the vasodilated state in advanced liver cirrhosis. Nat Med. 2001;7:827–32.

    Article  PubMed  CAS  Google Scholar 

  32. Chen YC, Gines P, Yang J et al. Increased vascular heme oxygenase-l expression contributes to arterial vasodilation in experimental cirrhosis in rats. Hepatology. 2004;39:1075–87.

    Article  PubMed  CAS  Google Scholar 

  33. Wiest R, Groszmann RJ. The paradox of nitric oxide in cirrhosis and portal hypertension: too much, not enough. Hepatology. 2002;35:478–91.

    Article  PubMed  CAS  Google Scholar 

  34. Iwakiri Y, Cadelina G, Sessa WC et al. Mice with targeted deletion of eNOS develop hyperdynamic circulation associated with portal hypertension. Am J Physiol Gastrointest Liver Physiol. 2002;283:GI074–81.

    Google Scholar 

  35. Rasaratnam B, Kaye D, Jennings G et al. The effect of selective intestinal decontamination on the hyperdynamic circulatory state in cirrhosis. A randomized trial. Ann Intern Med. 2003;139:186–93.

    PubMed  Google Scholar 

  36. Lopez-Talavera JC, Cadelina G, Olchowski J et al. Thalidomide inhibits tumor necrosis factor alpha, decreases nitric oxide synthesis, and ameliorates the hyperdynamic circulatory syndrome in portal hypertensive rats. Hepatology. 1996;23:1616–21.

    PubMed  CAS  Google Scholar 

  37. Lopez-Talavera JC, Merrill WW, Groszmann RJ. Tumor necrosis factor alpha: a major contributor to the hyperdynamic circulation in prehepatic portal-hypertensive rats. Gastroenterology. 1995;108:761–7.

    Article  PubMed  CAS  Google Scholar 

  38. Tsai MH, Iwakiri Y, Cadelina G et al. Mesenteric vasoconstriction triggers nitric oxide overproduction in the superior mesenteric artery of portal hypertensive rats. Gastroenterology. 2003;125:1452–61.

    Article  PubMed  CAS  Google Scholar 

  39. Arroyo Y, Colmenero J. Ascites and hepatorenal syndrome in cirrhosis: pathophysiological basis therapy and current management. J Hepatol. 2003;38:S69–89.

    Article  PubMed  Google Scholar 

  40. Ortega R, Gines P, Uriz J et al. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology. 2002;36:941–8.

    PubMed  CAS  Google Scholar 

  41. Schrier RW, Arroyo Y, Bernardi M et al. Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology. 1988;8:1151–7.

    Article  PubMed  CAS  Google Scholar 

  42. Zhang J, Ling Y, Luo B et al. Analysis of pulmonary heme oxygenase-l and nitric oxide synthase alterations in experimental hepatopulmonary syndrome. Gastroenterology. 2003;125:1441–51.

    Article  PubMed  CAS  Google Scholar 

  43. Luo B, Liu L, Tang L et al. ET-I and TNF-alpha in HPS: analysis in prehepatic portal hypertension and biliary and non biliary cirrhosis in rats. Am J Physiol Gastrointest Liver Physiol. 2004;286:G294–303.

    Article  PubMed  CAS  Google Scholar 

  44. Kim NH, Rubin LJ. Endothelin in health and disease: enothelin receptor antagonists in the management of pulmonary artery hypertension. J Cardiovasc Pharmacol Ther. 2002;7:9–19.

    Article  PubMed  CAS  Google Scholar 

  45. Michelakis ED, Tymchak W, Noga M et al. Long-term treatments with oral sildenafil is safe and improves functional capacity and hemodynamics in patients with pulmonary arterial hypertension. Circulation. 2003;108:2066–9.

    Article  PubMed  CAS  Google Scholar 

  46. Butterworth RF. Hepatic encephalopathy: a neuropsychiatric disorder involving multiple neurotransmitter systems. Curr Opin Neurol. 2000;13:721–7.

    Article  PubMed  CAS  Google Scholar 

  47. Blei AT. Diagnosis and treatment of hepatic encephalopathy. Baillieres Best Pract Res Clin Gastroenterol. 2000;14:959–74.

    Article  PubMed  CAS  Google Scholar 

  48. Larsen FS. Cerebral circulation in liver failure: Ohm’s law in force. Semin Liver Dis. 1996;16:282–92.

    Article  Google Scholar 

  49. Guevara M, Bru C, Gines P et al. Increased cerebrovascular resistance in cirrhotic patients with ascites. Hepatology. 1998;28:39–44.

    Article  PubMed  CAS  Google Scholar 

  50. Myers PP, Cerini R, Sayegh R et al. Cardiac hepatopathy: clinical, hemodynamic, and histologic characteristic correlations. Hepatology. 2003;37:393–400.

    Article  PubMed  Google Scholar 

  51. Inserte J, Perello A, Agullo L et al. Left ventricular hypertrophy in rats with biliary cirrhosis. Hepatology. 2003;38:589–98.

    Article  PubMed  CAS  Google Scholar 

  52. Ruiz-del-Arbol L, Urman J, Fernandez J et al. Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology. 2003;38:1210–18.

    Article  PubMed  Google Scholar 

  53. Kim WR, Brown RS, Terrault NA, El-Serag H. Burden of liver disease in the United States: Summary of a workshop. Hepatology. 2002;36:227–42.

    Article  PubMed  Google Scholar 

  54. Adams PC, Arthur MJ, Boyer TD et al. Screening in liver disease: report of an AASLD clinical workshop. Hepatology. 2004;39:1203–12.

    Google Scholar 

  55. Sandler RS, Everhart JE, Donowitz M et al. The burden of the selected digestive diseases in the United States. Gastroenterology. 2002;122:1500–11.

    Article  PubMed  Google Scholar 

  56. Boyer TD. Transjugular intrahepatic porto systemic shunt: current status. Gastroenterology. 2003;124:1700–10.

    Article  PubMed  Google Scholar 

  57. Arroyo V, Rodes J, Gutierrez-Lizarraga MA, Revert L. Prognostic value of spontaneous hyponatremia in cirrhosis with ascites. Am J Dig Dis. 1976;21:249–56.

    Article  PubMed  CAS  Google Scholar 

  58. Restuccia T, Gomez-Anson B, Guevara M et al. Effects of dilutional hyponatremia on brain organic osmolytes and water content in patients with cirrhosis. Hepatology. 2004 (in press).

    Google Scholar 

  59. Groszmann RJ, Garcia-Tsao G, Makuch R et al. Multicenter randomized placebo-controlled trial of non-selective beta blockers in the prevention of the complications of portal hypertension: final results and identification of a predictive factor. Hepatology. 2003;38:206A.

    Article  Google Scholar 

  60. Albornoz L, Bandi JC, Otaso JC et al. Prolonged bleeding time in experimental cirrhosis: role of nitric oxide. J Hepatol. 1999;30:456–60.

    Article  PubMed  CAS  Google Scholar 

  61. Van der Merwe SW, van den Bogaerde, Goosen C et al. Hepatic osteodystrophy in rats results mainly from portosystemic shunting. Gut. 2003;52:580–5.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Northwestern University Feinberg School of Medicine, 303 E Chicago Seale 10-573, Chicago, IL, 60611, USA

    Andres T. Blei

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  1. Andres T. Blei
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Editors and Affiliations

  1. Yale University School of Medicine, New Haven, CT, USA

    R. J. Groszmann

  2. Hepatic Hemodynamic Laboratory Liver Unit, Hospital Clinic, University of Barcelona, Spain

    J. Bosch

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Blei, A.T. (2004). Portal hypertensive syndrome: its importance and complications. In: Groszmann, R.J., Bosch, J. (eds) Portal Hypertension in the 21st Century. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-1042-9_1

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  • DOI: https://doi.org/10.1007/978-94-007-1042-9_1

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-3774-7

  • Online ISBN: 978-94-007-1042-9

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