Portal hypertension in children

Portal hypertension (PH) is an important complication of chronic liver disease. It can also be caused by a wide range of extrahepatic pathologies in children, and is often clinically silent. Acute variceal haemorrhage (VH) is the most serious consequence of portal hypertension associated with significant morbidity and mortality. Management of PH in children consists of medical, endoscopic and surgical approaches which are mainly focused on acute treatment as well as reducing the risk of variceal haemorrhage. Current treatment strategies for children with PH are mostly based on extrapolation of data from adult studies and expert opinion and consensus. A structured protocol, consisting of surveillance endoscopy with primary and secondary prophylactic therapy by endoscopic variceal ligation or sclerotherapy, is increasingly becoming the standard of care. This article discusses the causes and current treatment options for PH in childhood.