Portal hypertension refers to an increase in blood pressure inside the portal vein that occurs due to liver damage.
In this article, we discuss the symptoms and causes of portal hypertension. We also cover how doctors diagnose and treat this condition.
Portal hypertension occurs when the blood pressure in the portal vein exceeds 10 millimeters of mercury (mm Hg).
The portal vein carries nutrient-rich blood from the stomach, spleen, pancreas, and other digestive organs to the liver. The portal vein is not a true vein because it does not drain into the heart, but it provides about 75% of the liver’s blood supply.
The liver filters toxins from the blood and processes nutrients before sending them to the rest of the body. Problems that affect the liver, such as cirrhosis and inflammation, can also affect the portal vein.
Changes in the blood pressure inside the portal vein can lead to severe complications, such as gastrointestinal bleeding, infections, and kidney failure.
Most people experience no symptoms of portal hypertension until the disease progresses, or they develop complications.
Portal hypertension and its complications can lead to nonspecific symptoms, such as:
- varices, or enlarged veins, in the esophagus and stomach
- internal bleeding from broken or ruptured varices, which can lead to black or bloody stools
- ascites, or swelling of the abdomen, which occurs when fluid collects in the space between the inner abdominal wall and the organs
- encephalopathy, which damages the brain, leading to concentration and memory problems and other cognitive impairments
- anemia, or iron deficiency, which occurs as a result of chronic blood loss
- reduced blood clotting due to low platelet levels
- a weakened immune system as a result of reduced levels of white blood cells
Splenomegaly, which is an enlarged spleen, can also occur in some cases. Portal hypertension may decrease blood flow from the spleen, forcing this organ to grow larger to accommodate the excess blood. It may also cause hepatosplenomegaly, which is swelling of both the liver and spleen.
Cirrhosis is the most common cause of portal hypertension. Cirrhosis is a type of liver disease in which scar tissue replaces healthy liver tissue. This scar tissue can block the blood flow and increase the blood pressure inside the portal vein.
A person can develop cirrhosis as a result of:
- alcohol use disorder
- nonalcoholic fatty liver disease
- chronic hepatitis infections
- autoimmune diseases of the liver, such as primary sclerosing cholangitis and primary biliary cirrhosis
- liver congestion due to chronic heart failure
- long-term use of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and some antibiotics
Idiopathic noncirrhotic portal hypertension (INCPH) refers to portal hypertension that develops in people who do not have cirrhosis.
Causes of INCPH include:
- blood clots in the portal vein
- chronic bacterial or parasitic infections
- underdeveloped bile ducts
- having a weakened immune system
- Crohn’s disease
- inherited disorders, including Adams-Oliver syndrome and Turner syndrome
People with a high risk for liver disease and cirrhosis also have an increased risk for portal hypertension.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, people over the age of 50 are more likely to develop cirrhosis, and it is more common in males than in females.
Other factors that can increase a person’s risk for cirrhosis include:
Portal hypertension is difficult to diagnose from a person’s symptoms alone. However, a doctor may suspect that a person has portal hypertension if their medical history and current health status suggest that they have a high risk for cirrhosis.
Doctors can use several different tests to screen for and diagnose portal hypertension. Ultrasound imaging is a noninvasive procedure that uses high frequency sound waves to create images of the body’s internal structures.
Using ultrasound, a doctor can monitor the blood flow through the portal vein and evaluate the health of the stomach and spleen. They can also perform elastography using ultrasound imaging.
Elastography measures the elasticity of liver tissue. Areas with low elasticity suggest the presence of scar tissue.
If these tests yield inconclusive results, a doctor will likely perform a liver biopsy, which involves removing a small piece of liver tissue. A pathologist will examine the tissue sample for scarring, inflammation, and other signs of disease.
A doctor may prescribe one or more of the following medications for portal hypertension:
- beta-blockers, such as propranolol (Hemangeol), which help lower blood pressure
- vasodilators, such as isosorbide (Imdur, Monoket), which enlarge the veins and reduce the risk of bleeding
- lactulose, which is a synthetic sugar that doctors use to treat symptoms of hepatic encephalopathy
- antibiotics, such as rifaximin (Xifaxan), to treat bacterial infections and help lower the levels of toxins in the brain
- diuretics, including furosemide (Lasix) and spironolactone (Aldactone), which remove excess fluid from the body and may help relieve edema and ascites
The doctor may also suggest making certain lifestyle changes, such as:
- limiting or avoiding alcohol consumption
- quitting smoking
- reducing sodium intake
- exercising regularly
Some people undergo the following procedures for portal hypertension:
- Transjugular intrahepatic portosystemic shunt (TIPS): A procedure in which a surgeon places a mesh stent into the portal vein to reroute the flow of blood into the hepatic vein.
- Variceal ligation: A procedure that can prevent bleeding from varices. It involves a surgeon tying a rubber band around the enlarged vein.
- Paracentesis: An effective treatment for severe ascites. During this procedure, a doctor drains excess fluid in the abdomen through a hollow needle.
- Liver transplant: This complex surgical procedure involves replacing a diseased or damaged liver with a healthy one. Doctors usually reserve liver transplants for individuals who have end stage liver failure or liver cancer.
Increased blood pressure in the portal vein can lead to varices in the esophagus or stomach. These enlarged veins may rupture, causing internal bleeding, bloody stools, or anemia.
Other potential complications of portal hypertension include:
- jaundice, which causes yellowing of the skin and eyes
- ascites, which occurs when fluid collects in the abdomen
- edema or swelling in the legs and feet
- hepatic encephalopathy, which can lead to memory loss, personality changes, and confusion
- chronic infections
The following tips may help prevent portal hypertension:
- consuming alcohol in moderation
- quitting smoking or avoiding secondhand smoke
- eating a healthful diet
- exercising regularly
- maintaining a moderate body weight
- avoiding the overuse of certain medications that can damage the liver
- screening for liver disease
- getting hepatitis vaccinations
There are several treatment options for portal hypertension. People may require a combination of medication, lifestyle changes, and surgical interventions.
Treating the underlying causes of portal hypertension may help prevent further liver damage.
People who have severe liver damage or liver cancer may require a liver transplant.
Portal hypertension often develops as a result of cirrhosis. However, blood clots, autoimmune diseases, and chronic infections can also contribute to portal hypertension.
Without treatment, portal hypertension can lead to severe complications, such as chronic bleeding, abdominal swelling, and liver failure.
Doctors typically treat portal hypertension with a combination of blood pressure-lowering medication, lifestyle changes, and surgery.