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International Journal of Hepatology
Volume 2012 (2012), Article ID 879163, 8 pages
http://dx.doi.org/10.1155/2012/879163
Review Article

Etiology and Management of Hemorrhagic Complications of Portal Hypertension in Children

1Unidad de Hígado y Trasplante Hepático, Sanatorio de Niños, Alvear 863, Santa Fe, Rosario 2000, Argentina
2Service de Gastroentérologie, Hépatologie et Nutrition, CHU Sainte-Justine, Université de Montréal, 3175 Côte Sainte-Catherine, Montréal, QC, Canada H3T 1C5

Received 2 April 2012; Revised 13 August 2012; Accepted 16 August 2012

Academic Editor: Nir Hilzenrat

Copyright © 2012 Alejandro Costaguta and Fernando Alvarez. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Portal hypertension in children represents a particular diagnostic and management challenge for several reasons: (1) treatment outcomes should be evaluated in relationship with a long-life expectancy, (2) pediatric patients with portal hypertension constitute an heterogeneous population, both in terms of individual characteristics and diversity of liver diseases; making comparison between treatment outcomes very difficult, (3) application of techniques and procedures developed in adult patients (v.gr. TIPS) face size limitations in small children, and (4) absence of data from well-controlled trials in children forces pediatric specialists to adapt results obtained from adult cohorts suffering from diseases such as HCV and alcoholic cirrhosis. Despite those limitations, substantial progress in the treatment of children with portal hypertension has been achieved in recent years, with better outcomes and survival. Two main factors influence our therapeutic decision: age of the patient and etiology of the liver disease. Therefore, diagnosis and treatment of complications of portal hypertension in children need to be described taking such factors into consideration. This paper summarizes current knowledge and expert opinion.