Studies in portal hypertension

Our work focussed on one of the most frequent and serious complications of portal hypertension i.e. variceal bleeding. In particular, studies were initiated aimed at developing a more effective therapeutic strategy for the primary and secondary prevention of variceal bleeding. Aspects of primary prevention of variceal bleeding are discussed in Chapters 2, 3 and 4. Primary prevention implies the need to identify patients at risk. Chapter 2 discusses the feasibility of a simple radiological method to detect oesphageal varices and addresses the reliability of this approach in comparison with the more usual endoscopic diagnostic method. The majority of patients with oesphageal varices will remain free of bleeding. On the other hand, in a proportion of patients variceal haemorrhage will be a fatal event. Therefore, identification of risk factors for variceal bleeding is of paramount importance, in particular with respect to selecting patients for prophylactic therapy. In chapter 3 we report a study assessing the reliability of the NIEC risk score system and report on attempts to further improve its prognostic reliability. Chapter 4 reports the results of a multicentre randomized controlled trial assessing sclerotherapy as prophylaxis for first variceal bleeding. Variceal bleeding is a medical emergency associated with significant morbidity and mortality. In patients with active bleeding one of the medical priorities and challenges is to arrest bleeding. The results of a study on the use of thrombin as an endoscopic haemostatic agent are reported in chapter 5. A number of treatments have been proposed for the secondary prevention of variceal bleeding. Relative new therapeutic options are TIPS and endoscopic band ligation. In chapter 6 we report the results of a randomized controlled clinical trial comparing these treatment modalities, and discuss our results in the context of the cumulative results of comparable studies.

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