Pharmacological management of portal hypertension and its complications in children: lessons from adults and opportunities for the future

ABSTRACT

Introduction

Portal hypertension (PHT) and its complications in children are thought to be distinct from adult PHT in several areas, including the underlying bio-physiology of a child in which PHT develops, but also because of the pediatric-specific etiologies that drive disease progression. And yet pharmacologic approaches to PHT in children are mainly based on adult data, modified for pediatric practice. This reality has been driven by a lack of data specific to children.

Areas Covered

The authors discuss current therapeutic approaches to PHT in children, including management of acute gastrointestinal variceal bleed, pharmacotherapy in prophylaxis, and established and emerging therapies to combat systemic co-morbidities that result from PHT. The few areas where pediatric-specific data exist are highlighted and the many gaps in knowledge that remain unresolved are underscored.

Expert opinion

Despite decades of experience, optimal management of pediatric PHT remains undefined. In large part, this can be directly linked to a lack of basic understanding related to the unique pathophysiology and natural history that defines PHT in children. As a result, meaningful research into the utility and effectiveness of pharmacotherapy in children with PHT remains in its infancy. Large, multi-center, prospective studies will be needed to begin to establish an infrastructure on which a pediatric-specific research agenda can be built.

Key Words:

• Ascites
• Lactulose
• Octreotide
• Pediatrics
• Propranolol
• Spironolactone
• Variceal bleeding

Article Highlights

• Pediatric physiology and clinical outcomes associated with portal hypertension warrant consideration age-specific pharmacotherapeutic approaches;

• Octreotide and/or vasopressin, in combination with early variceal band ligation, is generally recommended for the treatment of acute variceal bleeding; however, widely accepted pediatric-specific societal guidelines are lacking;

• Large, multi-center, prospective studies are needed to establish an infrastructure on which a pediatric-specific research agenda can be built;

• Novel pharmacological agents targeting various co-morbid conditions associated with portal hypertension are being developed in adults and trials should be performed in children

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This manuscript was not funded.