Management of portal hypertension, Budd–Chiari syndrome and portal vein thrombosis

Portal hypertension is associated with many of the known complications of cirrhosis and has an enormous impact on patients’ prognosis. Ascites and hepatic encephalopathy represent the most common complications of cirrhosis; both are associated with a significantly worse prognosis, with 50% survival over 1–2 years. Acute variceal bleeding is a life-threatening complication, and despite significant improvements in the management it remains a leading cause of death in patients with cirrhosis. Advances in variceal bleeding management, including empirical antibiotic use, vasoactive drugs, early endoscopy and therapies such as transjugular intrahepatic portosystemic shunt (TIPSS) in patients with refractory bleeding, have resulted in improved mortality rates, currently around 11–20% per episode.