Proceedings of ESPGHAN monothematic conference 2024 (II): Management of portal hypertension in children and adolescents.

OBJECTIVE: To summarise current evidence and expert perspectives on the management of paediatric portal hypertension, primarily focusing on portal hypertensive varices and gastrointestinal bleeding in children, as discussed during the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) monothematic conference meeting on portal hypertension. METHODS: In 2024, an EPSGHAN 3-day monothematic conference on paediatric portal hypertension was held in Dublin (Ireland), gathering international experts in portal hypertension. The second part of the meeting focused on clinical algorithms for acute variceal bleeding, minimally invasive radiological treatments, surgical shunts, and indications for liver transplantation. Additional sessions examined methodological constraints affecting paediatric clinical trials, supported by case-based discussions and expert panel debates. RESULTS: Faculty outlined updated approaches to emergency management for upper gastrointestinal bleeding, including stabilisation, pharmacotherapy and endoscopy treatment. Minimally invasive radiological procedures and surgical treatments were reviewed. Sessions highlighted indications for transplantation and management of post-transplant portal vein thrombosis. Presentations on registries underscored their value in rare diseases. The final session detailed the statistical, ethical and logistical challenges inherent in paediatric clinical trials and specific challenges in portal hypertension trials. CONCLUSIONS: Current management strategies across medical, endoscopic, radiological and surgical fields were reviewed, recognising the scarcity of paediatric-specific evidence. Enhanced collaboration, harmonised registries, and standardised study designs were identified as vital next steps towards optimising outcomes in children with portal hypertension.