- Prof. Juan Carlos Garcia-Pagan, Spain
- Dr. Virginia Hernández-Gea, Spain
Program 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 in the pharmacologic & endoscopic management of Portal Hypertension
- Novel endovascular techniques: always the last step?
- Precision medicine in Portal Hypertension: are we there yet?
State of the art lecture:
Making Sense of Statistics in Clinical Trials: Lights and shadows of clinical studies generating evidence-based medicine
The field of portal hypertension (PHT) is currently challenged by variations in cirrhosis etiology ,and changes in the natural history of advanced chronic liver disease after controlling the etiological factor (i.e. SVR after HCV antiviral treatment). This last group of patients remain at high risk of developing PHT complications but should we manage these patients differentially?. In addition, improvement in diagnostic tools and awareness in the medical community have led to increase identification of other etiologies of portal hypertension different from cirrhosis that require an specific approach.
With the proposed program and activities the Barcelona Clinical School will provide the following outcomes adjusted to the different needs:
- PHT is not solely due to liver cirrhosis: we will provide real clinical cases in which the first clinical manifestation was a portal hypertension related complication in both 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. We will foster students to propose and discuss diagnostic and therapeutic algorithms during clinical case activities.
- Etiological treatments change the natural history of advanced chronic liver disease. Discussion with students and review the current evidence regarding how to manage these patients will be done during case discussions. As a matter of example, how to manage patients with clinical significant portal hypertension in whom, after etiological treatment, portal hypertension is just mild?
- The importance of an accurate diagnosis of the underlying disease. We will emphasize 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 to be done in the area.
- The role of traditional diagnostic methods in the current era. We will focus clinical cases on how HVPG measurement can help with the diagnosis and treatment of PHT related complication due to different etiologies. We’ll show the students how the measurements are done (real cases in our facilities) and how the tracings should be read. We will underline the minimum quality criteria required for a portal pressure measurement to be trusted and provided real cases of HVPG and PPG measurement after TIPS placement to show how a non-accurate result may impaired the management of the 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 portal hypertension including pharmacological and endoscopic strategies but also innovative endovascular techniques such as TIPS, interventional thrombosis recanalization and BRTO.
- Evidence based and individualized treatment of PHT. We will provide evidence and clinical examples focused on how stratifying patients according to their risk of treatment failure and bad outcome improves survival.
- Knowing how to interpret and criticize the methodology used in clinical studies is essential to understand evidence-based medicine. We aim to stimulate attendees into reviewing published studies critically and separate wheat from straw in the published RCT, Metanalysis or systematic reviews. A better understanding of clinical statistics will improve the quality of new generation of physicians. We will reinforce this concept analyzing with the attendees specific RCT/Metanalysis/Systematic reviews that try to answer specific questions raised by the patients presented during the clinical case discussions. This will be complemented with the state of the art session given by Dr. Rowe an excellent and deep analyst of potential bias and over interpretations of results obtained in clinical studies.
For any question, please contact: email@example.com