is portal hypertension always progressive or is it reversible.

[wurzle]

I have ALD and cirrhosis and been diagnosed with portal hyprrtension and 2 grade 1 varices (last endoscopy about 6 months ago). Will this inevitably progress until I start to have bleeds or is there a way to halt it or reverse it. I know there is a procedure called a shunt but when would they have to perform that?

[AyrshireK]

Are you currently on one of the liver safe beta blockers for portal hypertension? Often if you've not yet had a bleed they can/will prescribe carvedilol or propanolol to reduce the p/h and prevent portal hypertension from causing other issues.

A transjugular intrahepatic portosystemic shunt (TIPSS procedure) might be employed when someone has either got serious varices issues or ascites - it's more at the end of things where all else has failed and/or you are edging towards transplant needy because whilst TIPSS is good at preventing bleeds, helping with ascites prevention it is also not without it's own risks in that it can lead very quickly to symptoms of Hepatic Encephalopathy (HE) because blood which would usually filter through the liver (even a damaged liver) is detoxified to a degree but TIPSS is in effect a bypass or canal through the liver so the blood doesn't get to pass through liver tissues, it's quickly channelled through the shunt and therefore doesn't get any sort of detoxification and therefore those toxins can then build up in the blood and make there way to the brain. TIPSS can also be implicated in a slightly higher risk of stroke.

My hubby had 42 varices banded after a massive bleed in April 2012 (7 burst varices). His varices were deemed eradicated. He also had portal hypertensive gastropathy in his stomach and portal hypertension also lead to aneurysms in his splenic artery. He had an enlarged spleen do to P/H and this in turn led to low platelets etc.

Hubby wasn't put on on a beta blocker because they said it wasn't that effective once someone had bled though I know other members of the forum have been prescribed them even after a bleed.

Hubbies situation has changed somewhat in that due to the aneurysms in his splenic artery he had to have an embolization operation and this lead to the blood supply to/from his spleen being almost cut off and so his spleen all but died off. He had a splenic infarction - the result of which was a total reversal of his portal hypertension. Normal platelet count, normal liver bloods and he ended up being taken off the transplant list because he stabilized. (In some countries they actually do this partial splenic embolization procedure to actually help the struggling liver and hubbies went that way). His liver has been stable since 2015.

Katie

[wurzle in reply to AyrshireK]

Hi Katie. I was on beta blockers anyway - metoprolol for atrial fibrilation but I'll ask my consultant if this is also helping with PH. I'm glad to hear your husband is doing well. Its very lucky that the intervention to save his spleen, and his life, ended up completely reversing his PH. Wishing you and he all the best,

Phil x

[Ubwa]

Yes it can get better, but your enlarged spleen may not go back to a normal size as it’s not an elastic organ