Update on the Evaluation and Management of Portal Hypertension

Area of Science:

• Hepatology
• Gastroenterology
• Medical Diagnostics

Background:

• Clinically significant portal hypertension (CSPH) is a key predictor of adverse outcomes in chronic liver disease.
• The concept of compensated advanced chronic liver disease emphasizes portal hypertension (PH) over cirrhosis for clinical relevance.
• Accurate PH assessment is crucial for managing liver disease complications.

Purpose of the Study:

• To review recent advances in noninvasive methods for predicting PH.
• To discuss the evolving role of transient elastography (TE) in CSPH detection.
• To summarize current and emerging management strategies for PH.

Main Methods:

• Review of noninvasive diagnostic tools for PH, including transient elastography (TE), magnetic resonance elastography, and multiparametric MRI.
• Analysis of established and emerging TE cutoffs for diagnosing and ruling out CSPH.
• Evaluation of current therapeutic approaches for PH management.

Main Results:

• TE is becoming a primary clinical tool for estimating PH, with specific liver stiffness (LS) cutoffs for diagnosing (≥25 kPa) and excluding (<15 kPa with platelets >150 × 10⁹/L) CSPH.
• Incorporating splenic stiffness measurement with TE may enhance CSPH detection sensitivity.
• Nonselective β-blockers show potential beyond variceal bleed prevention; statin data is promising but requires further clinical trials; long-term albumin therapy needs more investigation.

Conclusions:

• Noninvasive methods, particularly TE, are advancing the prediction and diagnosis of CSPH.
• Optimizing TE and exploring splenic stiffness hold promise for improved CSPH detection.
• Further research is needed to solidify the roles of statins and albumin therapy in PH management.