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

Treatment of the primary cause of many chronic liver diseases(CLDs) may not be possible and serious complications like portalhypertension (PH) must be prevented or controlled enabling the childwith CLD to live with a good quality of life. Early detection of PHis achieved by history taking, examination, imaging techniques aswell as esophagogastroduodenoscopy (EGD). Primary preventionof first episode of variceal hemorrhage involves use of non-selectiveβ-blocker (NSBB) and rubber band endoscopic variceal ligation(EVL). Management of acute variceal bleeding includes effectiveresuscitation, prompt diagnosis, control of bleeding and preventionof complications. Prevention of secondary variceal hemorrhage isthrough a combination of EVL plus pharmacological therapy, othertherapies include surgical porto-systemic shunt (PSS) and Meso-Rexbypass. The goal of this review is to highlight the pediatrician rolein management of variceal bleeding in children with PH in order toimprove their survival and avoid its life-threatening complications.