Invited Commentary

Excerpt

This article (DOI: 10.1007/s00268-005-7656-9) reminds us that there is still a role for decompressive shunts to control variceal bleeding. The authors report on a small subset of their total population who have idiopathic portal hypertension and who are managed in this way. This manuscript therefore highlights two important but rare areas of portal hypertension and its management, and it is thus worthy of further comment. First, the disease is important in this field, because these patients usually have well-preserved liver function. Idiopathic portal hypertension and variceal bleeding has been described in various ways over the past four decades, but essentially it appears to be a thickening of the terminal portal venules, leading to increased resistance to portal flow and consequent portal hypertension. The hepatic sinusoid and overall hepatic architecture are maintained, and thus hepatic function is preserved. The cause remains obscure, but the end result of portal hypertension and variceal bleeding can be of major clinical significance and becomes the focus of treatment. …