Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice | May 2025-9_Kaplan_New techniques for the diagnosis and management of clinically significant portal hypertension

9_Kaplan_New techniques for the diagnosis and management of clinically significant portal hypertension

Pdf Summary

The presentation focuses on advancements in diagnosing and managing clinically significant portal hypertension (CSPH). Clinically significant portal hypertension is a critical condition that entails increased pressure in the liver's portal vein, impacting liver function and potentially leading to liver complications. This condition requires efficient diagnosis and management to prevent exacerbation.<br /><br />**Key Highlights:**<br /><br />1. **Funding and Conflicts:** Kaplan's research received grant funding from Gilead, AstraZeneca, Exact Sciences, and Bausch. He reports no conflicts related to the subject.<br /><br />2. **Identifying CSPH:** Noninvasive liver diagnostic assessments (NILDA) utilize liver stiffness measurement (LSM) and platelet count as key indicators. Specific thresholds indicate CSPH presence and its likelihood, with adjustments required for individuals with obesity and metabolic steatosis.<br /><br />3. **Varices Needing Treatment (VNT):** Special attention is given to understanding thresholds for esophageal varices that require treatment to prevent bleeding, as well as recognizing signs predictive of bleeding risk.<br /><br />4. **Emerging Treatments:** Carvedilol is highlighted as a preferred non-selective beta-blocker for managing CSPH due to its effectiveness in reducing intrahepatic vascular resistance and the associated risk of complications like ascites and variceal hemorrhage.<br /><br />5. **New Paradigm Shift:** Emphasizes a shift from solely monitoring varices needing treatment (VNT) to proactively identifying patients with CSPH and initiating NSBB treatment, such as carvedilol, to prevent decompensation. This approach reduces the necessity for frequent endoscopic screenings.<br /><br />The overall guidance underscores that early identification and proactive management of CSPH are key tactics in mitigating the risks of hepatic decompensation and complications associated with portal hypertension.

Keywords

portal hypertension

diagnosis

management

liver stiffness measurement

noninvasive liver diagnostic assessments

carvedilol

varices needing treatment

beta-blocker

hepatic decompensation

CSPH