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The past several years have seen a logarithmic increase in progress in the field of
portal hypertension, both in clinical management as well as in pathobiology. For example,
the implementation of beta-blockers in the primary and secondary prophylaxis of variceal
hemorrhage and the establishment of endoscopic variceal band ligation in the management
of acute variceal hemorrhage have become mainstays of clinical management of patients
with portal hypertension. From a scientific standpoint, discoveries such as the elucidation
of the hepatic stellate cell as a contractile sinusoidal effector cell and the understanding of
nitric oxide as a key mediator of vascular responses have provided a cellular framework for
the pathogenesis of portal hypertension. However, these discoveries and treatment advances
are just the tip of the iceberg, with new therapies and pathogenic principles coming
under scrutiny and likely to reach fruition in the years to come.



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