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Portale Hypertension und Varizen

Portal hypertension and varices

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Der Gastroenterologe Aims and scope

Zusammenfassung

Die portale Hypertension ist für prognoselimitierende Komplikationen einer Leberzirrhose verantwortlich. Die Varizenblutung stellt die zweithäufigste Komplikation dar und ist mit einer weiterhin hohen Mortalität verbunden. Dabei kann ein frühzeitiges Screening auf klinisch signifikante portale Hypertension und gastroösophageale Varizen die rechtzeitige Etablierung primärprophylaktischer Maßnahmen erlauben. Die Behandlung der akuten Varizenblutung erfolgt nach einer multimodalen Strategie aus medikamentöser Senkung des portalen Hypertonus, prophylaktischer Antibiose, restriktiver Transfusionstherapie und endoskopischer Blutstillung. Nach durchgemachter Blutung verhindert die frühe, präemptive Implantation eines transjugulären intrahepatischen portosystemischen Shunts (TIPS) innerhalb von 72 h bei ausgewählten Patienten mit fortgeschrittener Leberzirrhose Rezidivblutungen und reduziert die Mortalität. Patienten, bei denen kein TIPS angelegt wurde, sollten eine medikamentös-endoskopische Sekundärprophylaxe erhalten. Diese Übersichtsarbeit fasst die aktuellen Konzepte zu Diagnostik der portalen Hypertension und zur Prävention und Behandlung der Varizenblutung zusammen.

Abstract

Portal hypertension is the key pathomechanism underlying life-threatening complications of liver cirrhosis. Among these, variceal bleeding represents the second most common and the most lethal event. Early detection of clinically significant portal hypertension (CSPH) even in patients with compensated cirrhosis may allow for timely implementation of effective primary prophylaxis. Treatment of acute variceal hemorrhage itself follows a multimodal concept including medication to lower portal pressure, prophylactic antibiotic therapy, observation of a restrictive transfusion strategy and endoscopic interventions to stop the bleeding. In selected patients with advanced liver cirrhosis, pre-emptive implantation of a transjugular intrahepatic portosystemic shunt (TIPS) within 72 h after the initial bleeding event decreases the risk of rebleeding and improves survival. Patients who not undergoing TIPS implantation should receive combined pharmacological and endoscopic treatment as secondary prophylaxis. This review summarizes current concepts for the diagnosis of portal hypertension and for prevention and treatment of variceal hemorrhage.

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  1. Medizinische Klinik und Poliklinik (Gastroenterologie mit Sektionen Infektiologie und Tropenmedizin), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    J. Kluwe

  2. Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie, Infektiologie, Interdisziplinäre Endoskopie), Universitätsklinikum Jena, Friedrich-Schiller-Universität, Am Klinikum 1, 07747, Jena, Deutschland

    Alexander Zipprich

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A. Zipprich geht Vortragstätigkeiten am GORE (W.L. GORE & Associates, Inc. Newark, DE, USA) nach. J. Kluwe gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Kluwe, J., Zipprich, A. Portale Hypertension und Varizen. Gastroenterologe 16, 149–159 (2021). https://doi.org/10.1007/s11377-021-00516-4

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