Portal Hypertension school: course directors
- Prof. Juan Carlos Garcia-Pagan, Spain
- Dr Virginia Hernández-Gea, Spain
Programme Overview / Summary
- Epidemiology and etiology of portal hypertension: Is there a world beyond cirrhosis?
- HVPG measurement: How and when?
- Non-invasive evaluation of portal hypertension: Does it help?
- Update on the pharmacological and endoscopic management of portal hypertension
- Novel endovascular techniques: Always the last step?
- Precision medicine in portal hypertension: Are we there yet?
Portal hypertension school: State-of-the-art lecture by Dr Ian Rowe
Making sense of statistics in clinical trials: Lights and shadows of clinical studies generating evidence-based medicine
The field of portal hypertension (PHT) faces many current challenges, regarding the variations in the etiology of cirrhosis. It also changes in the natural history of advanced chronic liver disease, once the etiological factors have been checked (i.e. patients’ sustained virological response after receiving antiviral treatment for HCV). This group of patients remain at high risk of developing PHT complications, but should we manage them differentially? Additionally, an improvement in diagnostic tools and awareness in the medical community have led to an increase in the identification of other etiologies of portal hypertension, other than cirrhosis, requiring specific approaches.
With the proposed programme and activities, the Barcelona Clinical School on portal hypertension will provide the following outcomes, adjusted to different needs:
- PHT is not solely due to liver cirrhosis: The course will provide real clinical cases, in which the first clinical manifestation was a PHT-related complication in both the cirrhosis and non-cirrhosis etiology. We will work on finding similarities and differences regarding physical examination, symptoms, and characteristic findings in laboratory, imaging, and pathology exams. Participants will be encouraged to propose and discuss diagnostic and therapeutic algorithms during clinical case activities.
- Etiological treatments change the natural history of advanced chronic liver disease. Participants will be encouraged to discuss and review the current evidence on how to manage these patients, via case discussions, e.g. How should one manage patients with clinical significant PHT in whom, after etiological treatment, the PHT becomes mild?
- The importance of an accurate diagnosis of the underlying disease. We will emphasise the differences in prognosis, depending on underlying etiology and how patients should be treated according to evidence-based medicine. We will also underscore the lack of knowledge regarding specific aspects of management, what to do in such cases according to international consensus, and the research needed in this area.
- The role of traditional diagnostic methods in the current era. We will focus certain clinical cases on how HVPG measurement can help with the diagnosis and treatment of PHT-related complications, due to different etiologies. Students will see how measurements are taken (using real cases at the onsite facilities) and how tracings should be read. We will underline the minimum-quality criteria required for a portal pressure measurement to be trusted and provide real cases of HVPG and PPG measurement after TIPS placement, to illustrate how a non-accurate result may impair the management of patients.
- Better knowledge of the new therapeutic armamentarium available including drugs, endovascular, and non-invasive techniques. We will revise recent trials focused on the management of PHT, not only pharmacological and endoscopic strategies, but also innovative endovascular techniques such as TIPS, interventional thrombosis recanalisation, and BRTO.
- Evidence-based and individualised treatment of PHT. We will provide evidence and clinical examples focused on how stratifying patients according to their risk of treatment failure and bad outcomes can improve their survival.
- Knowing how to interpret and criticise the methodology used in clinical studies is essential for understanding evidence-based medicine. We will stimulate attendees to review published studies critically and to separate the wheat from straw in published RCT, metanalysis, or systematic reviews. Having a better understanding of clinical statistics will improve the quality of the next generation of physicians. We will reinforce this concept with the attendees by analysing specific RCT/metanalysis/systematic reviews that try to answer specific questions raised by the patients presented in the clinical case discussions. This will be complemented with the state-of-the art session given by Dr Rowe, an excellent and thorough analyst of potential bias and over-interpretations of results obtained in clinical studies.
About EASL Schools
The schools contribute to the training of new generations of hepatologists and are a major element of our association. Aimed at young fellows enrolled in hepatology-oriented departments or more experienced clinicians who want to be exposed to the newest trends in hepatology.
For selected applicants, EASL will cover transportation costs to attend the school and accommodation during the event (details will be provided individually once the selection process has been done).
Application is open to young fellows under the age of 35 (born after 3 July 1986) and/or still in training.
Approximately 30 places are available for each school and only EASL members are allowed to apply. Become an EASL member
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