Medical treatment of portal hypertension

In this chapter we give a quick review of the rationale for treatment of po rtal hypertension. The different scenarios for treatment of variceal bleedi ng will be discussed - that is, primary and secondary prophylaxis of varice al bleeding as well as the treatment of the acute bleeding episode. The rol e of the pharmacological, endoscopic and derivative treatments in each one of these scenarios will be discussed. Particular attention will be devoted to the potential role of the combination therapy of beta-blockers with isos orbide-5-mononitrate for preventing re-bleeding and to the best approach to patients with intolerance or contraindications to beta-blockers. We also g ive a rational review of the data comparing sclerotherapy against ligation as well as the potential role of the latter on primary prophylaxis.