Portal hypertension is an increase in pressure within the portal vein. The portal vein is the main vein that extends from the digestive organ to the liver.
The increased pressure is caused by a blockage (clot) in the blood flow from the digestive organs to the liver.
The increased pressure in the portal vein causes large veins (varices) to develop across the esophagus and stomach to bypass the blockage. The varices become very fragile and can bleed easily.
If the varices are discovered through a gastroscopy they are usually graded on a scale of 1 to 3, with 3 being the most dangerous to bleed.
In the US, they are graded on a scale of 1 to 4. (Esophageal varices will be discussed in greater detail on another article).
In my particular case, portal hypertension was caused by thrombosis or clotting of the portal vein due to an apparently unknown genetic defect, which was thought to be some kind of protein deficiency.
This cause often termed non-cirrhotic is not the most common cause of this condition, as is cirrhosis of the liver.
Cirrhosis results from the healing of a liver injury caused by hepatitis, alcohol abuse, or other causes of liver damage.
In cirrhosis, the scar tissue blocks the flow of blood through the liver and will slow it’s processing function.
Read more about my own personal Portal Hypertension Journey.
New Portal Hypertension Video:
If you are an alcoholic and have ALD or cirrhosis, don’t go beating yourself about. It’s not your fault! More than likely you have inherited some genes from your parents or grandparents, neither of whom you had any choice to select. I remember when I first qualified in medicine, esophageal varices were frightening. We had to watch people vomit their life blood. I have been there, and I was never so scared in my life, not even when I was shot at in Belfast in the 1970s!
If you have any symptoms of varices, go to the ED immediately. If you need advice, I am here as a doctor living with cirrhosis. Clint, who must be one of the most courageous and altruistic people I know, has my details. I’m sure he will forward any emails to me. Never suffer in silence, and never cover up for a loved one. Death will come to us all, but it should be in our own bed, not in ED.
And, as Dave Allen said, “May your God go with you”. Believe in a Higher Power……………
“On the subject of gastric varices you are right in saying that there is not much they can do for them, however beta blockers is still the standard preventative measure in this case. If it is any consolation to you, I had a bleed from the varices in my stomach back in 2004, and although I came close to be transfused, they stopped bleeding and it never came to that point. As far as varices being banded in the stomach I have never heard of this, and they only would do this for the esophogas. Like you son, my spleen is very enlarged also, and my liver function is good too. Shortly after doctors discovered my portal vein as being clotted, my gastroenterologist at that time ordered a follow up scope, and after that suggested removing my spleen. Fortunately we called the hematologist who I had seen initially and he said to me, “no one is touching your spleen”. At the point I switched over to another hospital and was referred to a gastroenterologist who agreed that removing my spleen was not in my best interests. A person can live without their spleen, however your immune system can be compromised without it, as I suppose it is anyways. If I were you I would get a second opinion if you can on this, and definitely do not take my word for it, as it may be better for your son not to have his spleen because of other complications I know nothing about. I know of a few people who really suffer with pain, and one person relates it as being spleen pain. You also mentioned that your son’s quality of life is good right now, and that is the same for me, so why compromise this by messing things up? About 5 years ago, under the suggestion of my current gastroenterolist she had a transplant team review my case for a multi organ transplant, which would have been an extremely rare operation. The complications of that would have been very serious, and if that would have not been an option then they were considering a shunting procedure – of which both were denied due to my current quality of life.”
I agree entirely. Though here, in the UK, they often prescribe cardioselective betablockers, as they claim that any beta-blockers will reduce portal hypertension. I am not so convinced. Does anyone know of any research which suggests the best beta-blockers for portal hypertension? I think the doctors here in the UK prescribe cardioselective betablockers as they are less likely to cause sleepiness? Is there any good research which suggests which betablockers to use for for portal hypertension?
Thanks
Tony
My husband suffers from portal hypertension do to fatty liver (NASH) cirrhosis. He also has clots in his portal and mesenteric veins. He has had stage 2 to 3 esophageal varices for a couple of years. When he had his most recent upper endoscopy, the doctor noted that he probably had portal hypertensive gastropathy as well. He did not mention it at the time, but I saw it on the report, when I got a copy for his primary care doctor. He has never had this before, and I am wondering if it means the portal hypertension is getting worse. He has been on betablockers for several years. I would appreciate any information, that anyone could share on this.
Might want to add that Dr. Stephen Dunn did my daughter’s REX shunt. He is affiliated with AI duPont Children’s hospital in Delaware.
Hi Marie, Thanks for providing this information … I will update the specialists list I have on this blog. Overall, how was the experience regarding your daughter? Do you have an idea how many Rex Shunts have been performed by Dr. Dunn?
Thanks again,
Clint
It may help people to know that there is not always a discrete division between the esophagus and the stomach. Many people who are liable to suffer from lower esophageal varices may have reflux conditions. This is where the stomach acid enters the base of the esophagus and causes erosion. Anatomical defects, such as hiatus hernia, are a frequent cause.
Tony
Kathy,
re. your post of 17 May.
Doctors often talk about “gastropathy” – all it means is some abnormal changes in the gastric tract. It does not always mean varices. The esophageal/stomach junction can be the source of the “gastropathy”, and this may involve varices if there is reflux associated with na hiatus hernia, for example. The stomach acid reacts with the esophageal lining in this case, and this can cause erosion and susceptibility to bleeding seen in the stomach. Antacids and/or proton pump inhibitors may be prescribed.
Tony
Hi there
Thought you might like to see this media clip. Unfortunately the reporter confused Evan’s heart defect with his portal hypertension, but we did not mind too much, as, on this occasion, we were trying to raise the profile of the hospital campaign (www.savelewishamhospital.com) not Evan’s condition/s.
http://www.itv.com/news/london/update/2013-01-26/20-000-march-against-lewisham-hospital-cuts/
Hi Eleanor,
Thank you for sharing this comment and the news clip featuring Evan and your local hospital. If you don’t mind I am going to re-share this clip in the form of a blog post, for the primary reason of outlining the dangers of portal hypertension and how it is imperative that we get to the hospital as fast as we can. Secondly, and not the least important of course is that we bring awareness to the detrimental consequences of hospital closures for the sake of peoples lives – especially our children. I’m not surprised that a reporter would make a mistake, but nevertheless it is an important topic and I think they got the point across very well.
Continued best for Evan … I will be praying.
Clint