What Are the Treatments for Portal Hypertension?

What Are the Treatments for Portal Hypertension?

The portal vein carries blood from the gastrointestinal tract to the liver. If this vein becomes blocked by cirrhosis which is a scarring of the liver or by a blood clot the pressure inside the vein increases. This increase in pressure is called portal hypertension. When blood flow through the liver becomes hindered by the blocked portal vein, new large veins called varices begin to form in the esophagus and stomach as a way of circumventing the blockage.

These veins are weak and bleed easily. Treatments for portal hypertension include medications, endoscopic therapy and altering hepatic blood flow.

Endoscopic Sclerotherapy and Endoscopic Banding

An endoscope is a thin, flexible tube with a light and a camera that doctors use to look inside the body. Two endoscopic procedures constitute initial treatment for portal hypertension, and both are performed by a gastroenterologist in a hospital, according to the Cleveland Clinic. One of these is called endoscopic sclerotherapy. In this procedure, the patient’s gastroenterologist guides an endoscope down the esophagus to locate the bleeding varices.

He then drops a needle down through the endoscope and injects a solution into the varices. The bleeding stops as the solution causes blood clots to form. In the endoscopic banding procedure, the gastroenterologist uses the endoscope to deploy rubber bands to tie off the blood supply to each of the varices.


According to the Merck Manual, the beta-blockers propranolol and nadolol are the primary long-term drug therapy for portal hypertension. These medications decrease the patient’s heart rate, which leads to diminished blood flow to the portal vein and a lower portal pressure. Patients who supplement beta-blocker therapy with the blood vessel dilating drug isosorbide mononitrate may achieve lower portal pressures than patients who are on beta-blockers alone. Lower pressure inside the portal vein reduces the risk of recurrent bleeding.

TIPS – Transjugular Intrahepatic Portosystemic Shunt

Patients with portal hypertension who don’t respond well to either endoscopic therapy or medications are candidates for a transjugular intrahepatic portosystemic shunt. According to the University of Maryland Medical Center, this is a procedure performed by a radiologist who is guided by X-ray images. It involves inserting a flexible tube attached to a stent through the jugular vein on the right side of the neck, and then running the stent down into a vein in the liver, called a hepatic vein.

The radiologist then uses the stent to connect the hepatic vein to the portal vein. This connection allows blood to flow freely from the gastrointestinal tract through the liver and back to the heart.

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