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Medical management of esophageal varices and portal hypertension in children.
Semin Pediatr Surg. 2012 Aug; 21(3):211-8.SP

Abstract

Portal hypertension (PH) is a common complication of chronic liver disease in children and represents a cause of morbidity and, rarely, mortality in this group of patients. Although often self-limiting, gastrointestinal bleeding in this setting is regarded as a frightening event by patients and carers, giving the impression of impending death. Therefore, it is important to raise the awareness on the natural history of PH in children, the utility of tools that help preventing and managing acute bleeding, and the signs predicting a poor outcome, thus indicating surgery. There is lack of data on the ability of endoscopy screening, endoscopic treatment of varices, and use of nonselective β-blockers to alter the outcome of PH in children; major efforts should be made to avoid such treatments empirically and promote multicenter trials instead. Nevertheless, such approach should be balanced against the need of offering the best care to children with PH. In this review, we discuss the advances made in the management of PH in children and compare it with the larger adult experience. A rational approach to acute gastrointestinal bleeding is proposed along with an algorithm suggesting a stepwise protocol to manage children with esophageal varices in the long-term, with some hints on possible future studies.

Authors+Show Affiliations

Paediatric Hepatology, Gastroenterology, and Transplantation, Ospedali Riuniti di Bergamo, Bergamo, Italy. ldantiga@ospedaliriuniti.bergamo.it

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22800974

Citation

D'Antiga, Lorenzo. "Medical Management of Esophageal Varices and Portal Hypertension in Children." Seminars in Pediatric Surgery, vol. 21, no. 3, 2012, pp. 211-8.
D'Antiga L. Medical management of esophageal varices and portal hypertension in children. Semin Pediatr Surg. 2012;21(3):211-8.
D'Antiga, L. (2012). Medical management of esophageal varices and portal hypertension in children. Seminars in Pediatric Surgery, 21(3), 211-8. https://doi.org/10.1053/j.sempedsurg.2012.05.004
D'Antiga L. Medical Management of Esophageal Varices and Portal Hypertension in Children. Semin Pediatr Surg. 2012;21(3):211-8. PubMed PMID: 22800974.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Medical management of esophageal varices and portal hypertension in children. A1 - D'Antiga,Lorenzo, PY - 2012/7/18/entrez PY - 2012/7/18/pubmed PY - 2012/12/10/medline SP - 211 EP - 8 JF - Seminars in pediatric surgery JO - Semin Pediatr Surg VL - 21 IS - 3 N2 - Portal hypertension (PH) is a common complication of chronic liver disease in children and represents a cause of morbidity and, rarely, mortality in this group of patients. Although often self-limiting, gastrointestinal bleeding in this setting is regarded as a frightening event by patients and carers, giving the impression of impending death. Therefore, it is important to raise the awareness on the natural history of PH in children, the utility of tools that help preventing and managing acute bleeding, and the signs predicting a poor outcome, thus indicating surgery. There is lack of data on the ability of endoscopy screening, endoscopic treatment of varices, and use of nonselective β-blockers to alter the outcome of PH in children; major efforts should be made to avoid such treatments empirically and promote multicenter trials instead. Nevertheless, such approach should be balanced against the need of offering the best care to children with PH. In this review, we discuss the advances made in the management of PH in children and compare it with the larger adult experience. A rational approach to acute gastrointestinal bleeding is proposed along with an algorithm suggesting a stepwise protocol to manage children with esophageal varices in the long-term, with some hints on possible future studies. SN - 1532-9453 UR - https://www.unboundmedicine.com/medline/citation/22800974/Medical_management_of_esophageal_varices_and_portal_hypertension_in_children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1055-8586(12)00029-7 DB - PRIME DP - Unbound Medicine ER -