Portal Hypertension in the 21st Century : The Proceedings of a Symposium Sponsored by Axcan Pharma Inc. And NicOx S.A., Held in Montrél, Canada, April 2–4, 2004

Portal hypertension is the most important complication of a great variety of both acute and chronic liver diseases. Nevertheless, hepatic cirrhosis is the most frequent cause of portal hypertension. Gastrointestinal bleeding due to rupture of oesophageal varices is, without doubt, the most severe complication of portal hypertension. At present, great advances are being made in the pathophysiology and in the development of new therapeutic tools for controlling and preventing this severe clinical event. This book contains the papers presented and discussed during the Symposium on 'Portal Hypertension in the 21st Century', held in Montréal, Canada, in April 2004, and sponsored by Axcan Pharma Inc. and NicOx S.A. There are eight sections covering basic mechanisms, new drugs, prevention and current treatment of variceal bleeding, prevention of recurrent bleeding and hepatic hemodynamic monitoring. An international faculty of authors have contributed chapters at an outstanding scientific level which will be vital reading for scientists and clinicians alike. Front Matter....Pages i-xviii Front Matter....Pages 1-1 Portal hypertensive syndrome: its importance and complications....Pages 3-12 The vascular endothelium and nitric oxide....Pages 13-18 Endothelial-derived nitric oxide as a marker for healthy endothelium....Pages 19-23 Front Matter....Pages 25-25 Mechanisms of hepatic fibrogenesis....Pages 27-35 The role of hepatic stellate cells/myofibroblasts....Pages 37-46 Structural changes in the liver leading to cirrhosis and portal hypertension....Pages 47-53 Front Matter....Pages 55-55 The paradox: vasoconstriction and vasodilation....Pages 57-67 Nitric-oxide-mediated vasodilation and portal hypertension....Pages 69-80 Impaired vasodilation in cirrhotic livers....Pages 81-88 Enhanced release of vasoconstrictors....Pages 89-96 Endogenous cannabinoids and circulatory dysfunction in cirrhosis....Pages 97-101 Front Matter....Pages 103-103 NCX-1000: a liver-specific NO donor....Pages 105-110 Possibilities of manipulating nitric oxide biosynthesis in the treatment of portal hypertension: statins....Pages 111-120 Pathophysiological role of Akt and endothelial nitric oxide synthase in cirrhosis....Pages 121-126 Nitric oxide synthase gene transfer....Pages 127-131 Inhibition of nitric-oxide-mediated vasodilation (including K + channels)....Pages 133-143 Front Matter....Pages 145-145 Esophageal varices: from appearance to rupture; natural history and prognostic indicators....Pages 147-154 Pathophysiology of variceal bleeding....Pages 155-166 Approaches to the management of pediatric portal hypertension: results of an informal survey....Pages 167-172 Front Matter....Pages 173-173 Therapeutic tools in portal hypertension: drugs....Pages 175-184 Front Matter....Pages 173-173 Endoscopy in the management of portal hypertension....Pages 185-207 Transjugular intrahepatic portosystemic shunt (TIPS): current indications....Pages 209-217 Front Matter....Pages 219-219 Prevention of first variceal bleeding: drugs....Pages 221-226 Prevention of first variceal bleeding: endoscopy....Pages 227-231 Treatment of acute variceal bleeding: general management and prevention of infections....Pages 233-240 Hemostatic treatments....Pages 241-249 Prevention of recurrent portal hypertensive bleeding....Pages 251-260 Cost-effectiveness of primary prophylaxis for esophageal variceal bleeding....Pages 261-267 Front Matter....Pages 269-269 The cirrhotic patient with no varices and with small varices....Pages 271-276 Gastric varices....Pages 277-300 The patient who cannot receive beta-blockers....Pages 301-307 Hepatic venous pressure gradient: the facts....Pages 309-322 Hemodynamic monitoring: implications for randomized controlled trials and clinical practice....Pages 323-336 What to do with non-responders....Pages 337-348 What else we need....Pages 349-360 Back Matter....Pages 361-370 Portal hypertension is the important complication of a variety of acute and chronic liver diseases. This book contains the papers presented and discussed during the Symposium on 'Portal Hypertension in the 21st Century', held in Montreal, Canada, in April 2004. It contains eight sections covering basic mechanisms, new drugs, prevention and more.