New developments in portal hypertensive bleeding

Portal hypertensive bleeding can arise from a spectrum of conditions, including esophageal, gastric, and ectopic varices, portal gastropathy, and portal colopathy. Esophageal variceal hemorrhage causes the greatest morbidity and mortality and occurs through a combination of elevated portal pressure and local factors within the varix itself. Management of esophageal varices encompasses the primary prophylaxis of variceal hemorrhage, treatment of actively bleeding varices, and secondary prophylaxis to prevent variceal rebleeding. Therapeutic approaches for these different clinical scenarios include pharmacology therapy with octreotide or beta-adrenergic blocking agents, endoscopic therapy with variceal band ligation and sclerotherapy, and portosystemic shunts performed either surgically or by interventional radiography.