Elsevier

Journal of Hepatology

Volume 43, Issue 1, July 2005, Pages 167-176
Journal of Hepatology

Special report
Evolving Consensus in Portal Hypertension Report of the Baveno IV Consensus Workshop on methodology of diagnosis and therapy in portal hypertension

https://doi.org/10.1016/j.jhep.2005.05.009Get rights and content

Section snippets

Definition of key events regarding the bleeding episode

Definitions and criteria to evaluate failure to control bleeding and failure to prevent rebleeding were introduced at Baveno II [3], [4] and reviewed at Baveno III [7], [8]. Since then, these definitions and criteria have been extensively applied in trials; it has been found that some of them are rather difficult to apply and do not reflect adequately the situation in clinical practice; therefore, new definitions and criteria were proposed at Baveno IV. Given the lack of validated parameters to

Predictive models for portal hypertension

Because of the growing importance of prognostic models in hepatology, and particularly in portal hypertension, a session devoted to this topic was introduced in Baveno IV, to replace the session that was dedicated to the diagnosis of portal hypertension in Baveno III.

Status classification of cirrhosis

  • Varices, ascites and bleeding in patients with cirrhosis identify four clinical statuses of increasing severity: stage 1: no varices, no ascites; stage 2: varices, no ascites; stage 3:

Pre-primary prophylaxis (prevention of the formation/growth of varices)

Background

  • Prevention of the development of complications of portal hypertension is clearly an important area for future research.

  • Portal-systemic collaterals may develop before the appearance of varices, and can be diagnosed non-invasively. However, their clinical importance is uncertain (5;D).

  • HVPG is predictive of varices formation (1b;A).

Recommendations for management

  • All cirrhotic patients should be screened for varices at diagnosis (5;D).

  • Despite some pharmaco-economical analysis, it is not

Non-cirrhotic portal hypertension

A session devoted to non-cirrhotic portal hypertension was introduced at Baveno IV, in view of the increasing recognition and growing interest of this clinical entity. Due to time constraints, the discussion was limited to the Budd-Chiari syndrome [BCS—hepatic venous outflow tract obstruction (HVOTO)] and to extra-hepatic portal vein obstruction (EHPVO).

This session replaced the session that in Baveno III was devoted to portal hypertensive gastropathy and gastric varices.

Providing scientific evidence: RCTs and beyond

In previous Baveno workshops, a session was devoted to the methodological requirements for future trials in portal hypertension. At Baveno IV this session was replaced by one addressing some aspects of therapy in clinical practice that have not been or cannot be evaluated by RCTs, due to: (a) inadequate quality of trials, (b) uncommon diseases or (c) distinct features of the more common diseases. Addressing these issues should contribute to EBM when adequate information from RCTs is not

Conclusions

The purpose of the consensus definitions about the variceal bleeding episode is to use them in trials and other studies on portal hypertension, as well as in clinical practice. This does not mean that authors cannot use their own definitions, but they are encouraged to use and evaluate in parallel these Baveno IV consensus definitions. This should result in some measure of standardisation and increased ease of interpretation among different studies. Equally important, if there are uniformly

Participants

The following chaired sessions during the Workshop:

Jaime Bosch, M.D., Barcelona, Spain; Andrew K Burroughs, M.D., London, U.K.; Gennaro D'Amico, M.D., Palermo, Italy; Juan Carlos Garcia-Pagàn, M.D., Barcelona, Spain; Guadalupe Garcia-Tsao, M.D., New Haven, CT, USA; Norman D Grace, M.D., Boston, MA, USA; Roberto Groszmann, M.D., New Haven, CT, USA; Patrick Kamath, M.D., Rochester, MN, USA; Loren Laine, M.D., Los Angeles, CA, USA; Didier Lebrec, M.D., Clichy, France; Carlo Merkel, M.D., Padua,

Acknowledgements

The Baveno IV workshop was endorsed and supported in part by a unrestricted educational grant of the European Association for the Study of the Liver (EASL).

The Baveno IV workshop was also endorsed by the Italian Association for the study of the liver (AISF), the Italian Association of hospital gastroenterologists and endoscopists (AIGO), the Italian association for digestive endoscopy (SIED) and the Italian Society of Gastroenterology (SIGE).

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On behalf of the Baveno IV Chairpersons and panellists.

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