Portal hypertension and oesophageal varices

Portal hypertension is a result of a combination of increased portal resistance and increased blood flow in the portal system. The cause is a blockage of the portal blood flow to systemic circulation due to prehepatic, intrahepatic and posthepatic disorders. The clinical signs are sequelae of the development of portosystemic collaterals for decompression. Drug, endoscopic and surgical treatment for acute therapy and longterm prophylaxis is available. Acute hemorrhage is treated with endoscopic sclerotherapy or rubberband ligation,Vasopressin or Somatostatin and their analogs can acutely reduce portal hypertension. Therapy of portal vein thrombosis consists of endoscopic treatment and shuntsurgery. In liver cirrhosis the only curative treatment is liver transplantation. In this article the pathophysiology and different treatment modalities including their indication are discussed.