Management of Portal Hypertension in Children: A Focus on Variceal Bleeding

Abstract

Treatment of the primary cause of many chronic liver diseases (CLDs) may not be possible and serious complications like portal hypertension (PH) must be prevented or controlled enabling the child with CLD to live with a good quality of life. Early detection of PH is achieved by history taking, examination, imaging techniques as well as esophagogastroduodenoscopy (EGD). Primary prevention of first episode of variceal hemorrhage involves use of non-selective β-blocker (NSBB) and rubber band endoscopic variceal ligation (EVL). Management of acute variceal bleeding includes effective resuscitation, prompt diagnosis, control of bleeding and prevention of complications. Prevention of secondary variceal hemorrhage is through a combination of EVL plus pharmacological therapy, other therapies include surgical porto-systemic shunt (PSS) and Meso-Rex bypass. The goal of this review is to highlight the pediatrician role in management of variceal bleeding in children with PH in order to improve their survival and avoid its life-threatening complications.

Key words: Chronic liver disease; Portal Hypertension