Proceedings of ESPGHAN monothematic conference 2024 (I): Aetiology, diagnosis and complications of portal hypertension in children and adolescents.

OBJECTIVES: The hepatology committee of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) aims to provide education on key aspects of paediatric hepatology. Here we provide recent developments in the understanding, diagnosis and clinical consequences of portal hypertension (PHT) in children and young people, an area in which evidence remains scarce and fragmented. METHODS: In 2024, an EPSGHAN 3-day monothematic conference on paediatric PHT, held in Dublin (Ireland), brought together international experts in PHT. The first sessions of the conference were dedicated to PHT classification, pathophysiology, epidemiology, diagnostic dilemmas and major complications. Lectures have been integrated to provide an up-to-date overview of clinical practice. RESULTS: Opening sessions addressed the definition and classification of paediatric PHT, highlighting key differences between cirrhotic and non-cirrhotic causes. Advances in diagnostic imaging, the role of non-invasive tests and biopsy limitations are reviewed. Subsequent discussions focused on the mechanisms and management of major complications, including renal impairment, encephalopathy, cardiopulmonary dysfunction and endocrine consequences. Nutritional challenges and the interaction between PHT and gut-liver axis were emphasised as possible determinants of outcomes. CONCLUSIONS: This report summarises the key learning points of the first part of the meeting. These discussions set the foundation for defining research priorities and improving early recognition and multidisciplinary care strategies.