The early prevention of portal hypertension.

What is it about?

For decades, physicians have been passive witnesses of the spontaneous course of many morbid processes. The beneficial aspect of this story, if any, has been the chance for a meticulous observation and description of “the natural history of the disease”. In the particular case of cirrhosis and portal hypertension, the usual diagnostic scenario was (and still is in many cases) along the occurrence of any of their most frequent complications: variceal bleeding, ascites, hepatic encephalopathy and/or liver failure. Unavailability of adequate therapeutic resources and the late disease stage at which they presented translated into frustrating results in surviving terms. Accordingly, we were used, and almost resigned, to witness the end stretch of chronic liver diseases’ natural history. The natural history of cirrhosis includes several progressive stages, along which, and according to the presence or absence of clinically significant portal hypertension, a predictive prognosis of survival and/or chance of complications development can be established. Recent, strong advances in the knowledge of the reciprocal relationship between liver disease progression and portal hypertension allowed not only to understand very intimate mechanisms of both syndromes but also to develop new and earlier therapeutic measures that changed the concept of an inexorable and unidirectional route for chronic liver diseases. New, sensitive imagen techniques have also been of tremendous help in this area, and have displaced the need for a liver biopsy in many cases. Therefore, the earliest implementation of treatments, some of which etiology-related and some others administered on a rational basis allows nowadays to stop liver disease evolution and eventually, to observe a partial or complete regression of liver structural abnormalities. As a parallel, and desired consequence, an improvement in portal hypertension will correlate with a lesser chance of complications development and an improved prognosis.

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