In people with portal hypertension, there is increased pressure in the portal vein—the major vein transporting blood through your liver. Cirrhosis is the most common cause of portal hypertension, though it may also develop in people with blood clots in the portal vein or a parasitic infection called schistosomiasis. At NewYork-Presbyterian, our liver disease specialists have the skills and expertise to care for people with portal hypertension and are leaders in the development of innovative treatments for this disease.
A Team of Liver Disease Experts
Your care team includes hepatologists (liver specialists), gastroenterologists, interventional radiologists, surgeons, nurses, physician assistants, registered dietitians, social workers, and others with experience caring for people with portal hypertension and other liver diseases. Your team uses comprehensive diagnostic testing to diagnose portal hypertension, including endoscopy, ultrasound, MRI and other imaging tests. If you develop complications such as varices (enlarged blood vessels in the esophagus, stomach, and rectum, which can rupture), encephalopathy (confusion or forgetfulness), or ascites (fluid collection in your abdomen), our experts can treat those conditions. You can receive all the care you need at one medical center.
Medications to Treat Portal Hypertension
Your doctor may first treat you using medications such as beta blockers (which lower blood pressure) to prevent bleeding from varices, and diuretics to reduce fluid accumulation due to ascites. You may also receive an antibiotic such as Rifaximin and/or lactulose, a type of laxative, to reduce confusion and other mental changes resulting from encephalopathy.
Our registered dietitians will work with you to help tailor a nutrition plan to support your health, including a low-salt diet and avoidance of alcohol.
Procedures to Relieve Portal Hypertension
The doctors at NewYork-Presbyterian offer a range of procedures to treat portal hypertension and its complications if medications are not sufficient.
- Band Ligation. A gastroenterologist uses rubber bands to tie off varices, reducing blood flow and pressure and lowering the likelihood that the varices will rupture.
- Sclerotherapy. Your doctor injects 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. We only perform sclerotherapy if you are bleeding and band ligation not an option for you.
- Transjugular intrahepatic portosystemic shunt (TIPS). You may have this procedure if band ligation and sclerotherapy cannot stop bleeding from varices and/or when diuretic medication is not effective for controlling ascites. Guided by x-rays and ultrasound imaging, an interventional radiologist creates a small hole in the portal vein and inserts a stent (a small tube) into it, creating a shunt. He or she then connects the shunt to one of the hepatic veins, creating another pathway which blood can flow through and reducing pressure in your portal vein as well as other abdominal veins.
- Balloon-occluded retrograde transvenous obliteration (BRTO). This is another procedure that is used as an adjunct or alternative to TIPS to manage certain types of varices (gastric varices, which are varices that come from the stomach). The procedure involves blocking the dilated vessels with a balloon, reducing the risk of rupture or to stop the bleeding.
- Distal splenorenal shunt (DSRS). During this procedure, a surgeon connects the splenic vein to the left kidney vein to lower pressure in varices and control bleeding. DSRS is a surgical procedure that requires a longer hospital stay afterward when compared with TIPS or other treatments.
Liver Transplantation for Portal Hypertension
If your portal hypertension cannot be effectively treated through other means and becomes life-threatening, you may need a liver transplant. At NewYork-Presbyterian, you are ten times more likely to receive a liver transplant than at other hospitals in the region, with an average wait time of just nine months. Our surgeons have performed more than 2,000 liver transplants, with outcomes that meet or surpass national averages. They use a variety of liver transplant approaches, including living donor liver transplantation, to extend the limits of organ transplantation and provide the greatest number of transplants possible.
Clinical Trials for Portal Hypertension
NewYork-Presbyterian physicians have been the lead researchers in many clinical trials studying new devices, techniques, and medications to improve outcomes in patients with portal hypertension. Some of these trials have resulted in the approval of new drugs and devices in the United States. You may have the opportunity to participate in a clinical trial of a promising new treatment.