Portal Hypertension

The most common cause is resistance to blood flow through a scarred liver (cirrhosis from hepatitis B or C, fatty liver, alcohol or other causes). It can also be caused by a clot in the portal vein before the liver or by diseases of the liver's small blood vessels. Blood flow into the portal system also increases in advanced liver disease, which adds to the pressure.

It is a common consequence of cirrhosis of any cause. It can also occur, less often, with clots in the portal vein or with other liver and blood vessel conditions, sometimes even in people with a liver that is not scarred, and in children.

If you have cirrhosis and plan to fast during Ramadan or travel for Hajj or Umrah, speak to your liver team beforehand about your medicines, salt, fluids and the risk of bleeding or dehydration.

Diagnosis is based on liver disease, imaging and endoscopy. Ultrasound, CT or MRI may show an enlarged spleen, ascites, collateral veins or a clot in the portal vein. Endoscopy (a camera through the mouth) looks directly for varices in the esophagus and stomach. FibroScan, spleen size and platelet counts help estimate the risk. Pressure in the liver veins can be measured in specialist centers when needed.

If you vomit blood, do not try to treat it at home; call emergency services. For everyday care:

• Avoid alcohol completely

• Take your preventive medicines and attend endoscopy appointments

• Avoid anti-inflammatory painkillers (ibuprofen, diclofenac, aspirin) unless your doctor says it is safe, because they raise bleeding risk

• Weigh yourself regularly if you have ascites

• Treat the underlying liver disease as advised

Nutrition protects strength and helps control fluid.

• Follow the salt limit from your doctor to reduce fluid build-up

• Eat regular meals and enough protein; avoid long fasting gaps

• Avoid very hard, sharp or rough foods that could scratch the esophagus if you have varices, and chew well

• Avoid raw shellfish and unsafe food

Your doctor chooses medicines according to your risks.

• Beta-blockers or similar medicines are often used to lower pressure and the risk of bleeding from varices

• Water tablets (diuretics) and salt restriction for ascites

• Antibiotics to prevent or treat infection in selected situations

• Blood thinners may be used if a portal vein clot is found; this must be decided by a specialist

• Do not stop or change these medicines yourself

Endoscopic and radiology procedures prevent and treat bleeding.

• Endoscopy to screen for varices and to treat them with bands (band ligation)

• Emergency endoscopy, medicines and sometimes a stent or balloon for active bleeding

• TIPS: a radiology procedure creating a channel in the liver to lower portal pressure, for selected patients

• Paracentesis to drain troublesome ascites

• Liver transplant assessment for advanced cirrhosis

Portal hypertension is a sign of advanced liver disease, but its complications can often be prevented or treated. Screening for varices and treatment to prevent first bleeding reduce the risk considerably. Bleeding is serious and needs immediate hospital care. The long-term outlook depends on the underlying liver disease and on how well it can be treated.

• Do I have varices, and how often do I need endoscopy?

• Should I take medicines to prevent bleeding?

• What should I do and where should I go if I vomit blood?

• Which medicines and painkillers should I avoid?

• Could I be a candidate for TIPS or transplant assessment?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.