Consensus report

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consensus report

Austrian consensus on the definition and treatment of portal hypertension and its complications (Billroth II)   

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Österreichischer Konsensus zur Definition und 

Therapie der Portalen Hypertension und ihrer 

Komplikationen (Billroth II)

Zusammenfassung  Im November 2004 hielt die Öster-

reichische Gesellschaft für Gastroenterologie und He-

patologie (ÖGGH) den ersten Konsensus über die De-

finitionen und die Therapie der Portalen Hypertension 

und ihrer Komplikationen im Billroth-Haus in Wien, 

Österreich ab (Billroth I Meeting). Diesem Treffen ging 

ein internationales Expertenmeeting über die Portale 

Hypertension mit einigen wichtigen Proponenten der 

Baveno Konsensus-Konferenzen vorraus (http://www.

oeggh.at/videos.asp). Der Konsensus selber basiert auf 

dem Baveno III Konsensus im Hinblick auf die portal-

hypertensive Blutung und den Vorschlägen des Interna-

tional Ascites Club in Hinblick auf die Therapie des As-

zites. Deren Aussagen wurden mit neuen Erkenntnissen 

aus der rezenten Literatur und auch entsprechend der 

praktischen Erfahrung der Teilnehmer des Konsensus-

Treffens modifiziert. Im Oktober 2001 organisierte die 

ÖGGH das zweite Konsensus Treffen über die porta-

le Hypertension und ihrer Komplikationen (Billroth II 

Meeting). Die Billroth II Leitlinien über die Definitionen 

und die Therapie der Portalen Hypertension und ihrer 

Komplikationen lassen die Entwicklungen der letzten 

7 Jahre inklusive des Baveno V Updates und etlicher 

Schlüsselpublikationen mit einfließen und stellen den 

neuen Standard im Management der Portalen Hyper-

tension in Österreich dar.

Schlüsselwörter:  Aszites, Varizenblutung, TIPS, Hepa- 

torenales Syndrom, Hepatopulmonales Syndrom, 

Portopulmonale Hypertension, Budd-Chiari Syndrom, 

Somatostatin, Terlipressin, Carvedilol

Wiener klinische Wochenschrift

The Central European Journal of Medicine

Wien Klin Wochenschr

DOI 10.1007/s00508-013-0337-z

Austrian consensus on the definition and treatment of 

portal hypertension and its complications (Billroth II)

Markus Peck-Radosavljevic, Bernhard Angermayr, Christian Datz, Arnulf Ferlitsch, Monika Ferlitsch, 

Valentin Fuhrmann, Michael Häfner, Ludwig Kramer, Andreas Maieron, Berit Payer, Thomas Reiberger, 

Rudolf Stauber, Rudolf Steininger, Michael Trauner, Siegfried Thurnher, Gregor Ulbrich, Wolfgang Vogel, 

Heinz Zoller, Ivo Graziadei

Received: 10 September 2012 / Accepted: 15 February 2013

© Springer-Verlag Wien 2013

For the Austrian Society of Gastroenterology and Hepatology 

(ÖGGH)

M. Peck-Radosavljevic, MD () · A. Ferlitsch, MD · 

M. Ferlitsch, MD · V. Fuhrmann, MD · B. Payer, MD · 

T. Reiberger, MD · M. Trauner, MD

Klinische Abteilung für Gastroenterologie und Hepatologie, 

Universitätsklinik für Innere Medizin III, Medizinische Universität 

Wien, Währinger Gürtel 18–20, 1090 Vienna, Austria

e-mail: [e-mail]

B. Angermayr, MD

2. Medizinische Abteilung, Landesklinikum St. Pölten, St. Pölten, 

Austria

C. Datz, MD

Abteilung Innere Medizin, Krankenhaus Oberndorf, Oberndorf bei 

Salzburg, Austria

M. Häfner, MD

Krankenhaus St. Elisabeth, Vienna, Austria

L. Kramer, MD · G. Ulbrich, MD

1. Medizinische Abteilung mit Gastroenterologie, Krankenhaus 

Hietzing, Vienna, Austria

A. Maieron, MD

4. Interne Abteilung, Krankenhaus St. Elisabeth, Linz, Austria

R. Stauber, MD

Klinische Abteilung für Gastroenterologie und Hepatologie, 

Medizinische Universität Graz, Graz, Austria

R. Steininger, MD

Universitätsklinik für Chirurgie, Medizinische Universität Wien, 

Vienna, Austria

S. Thurnher, MD

Klinische Abteilung für Radiologie und Nuklearmedizin, 

Krankenhaus Barmherzige Brüder Wien, Vienna, Austria

W. Vogel, MD · H. Zoller, MD · I. Graziadei, MD

Universitätsklinik für Innere Medizin (Gastroenterologie  

und Hepatologie), Medizinische Universität Innsbruck,  

Innsbruck, Austria

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    Austrian consensus on the definition and treatment of portal hypertension and its complications (Billroth II)

consensus report

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Summary  In November 2004, the Austrian Society of 

Gastroenterology and Hepatology (ÖGGH) held for 

the first time a consensus meeting on the definitions 

and treatment of portal hypertension and its complica-

tions in the Billroth-Haus in Vienna, Austria (Billroth 

I-Meeting). This meeting was preceded by a meeting of 

international experts on portal hypertension with some 

of the proponents of the Baveno consensus conferences 

(http://www.oeggh.at/videos.asp). The consensus it-

self is based on the Baveno III consensus with regard 

to portal hypertensive bleeding and the suggestions of 

the International Ascites Club regarding the treatment 

of ascites. Those statements were modified by new 

knowledge derived from the recent literature and also 

by the current practice of medicine as agreed upon by 

the participants of the consensus meeting. In October 

2011, the ÖGGH organized the second consensus meet-

ing on portal hypertension and its complications in Vi-

enna (Billroth II-Meeting). The Billroth II-Guidelines on 

the definitions and treatment of portal hypertension and 

its complications take into account the developments of 

the last 7 years, including the Baveno-V update and sev-

eral key publications.

Keywords: Ascites, Variceal bleeding, TIPS, Hepatorenal 

syndrome, Hepatopulmonary syndrome, Portopulmo-

nary hypertension, Budd-Chiari Syndrome, Somatosta-

tin, Terlipressin, Carvedilol

Abbreviations

AVB 

 Acute variceal bleeding

BCS 

 Budd-Chiari  syndrome

CSPH 

 Clinically significant portal hypertension

FCB 

 Failure to control bleeding

FFP 

 Fresh frozen plasma

GAVE 

 Gastric antral vascular ectasia

GOV 

 Gastro oesophageal varices

HCC 

 Hepatocellular  carcinoma

HE 

 Hepatic  encephalopathy

HPS 

 Hepatopulmonary  syndrome

HRS 

 Hepatorenal  syndrome

HVPG 

 Hepatovenous pressure gradient

IGV 

 Isolated gastric varices

ISMN 

 Isosorbidmononitrate

NSBB 

 Nonselective  beta-blockers

PPHTN 

 Portopulmonary  hypertension

PTFE 

 Polytetrafluoroethylene

PHG 

 Portal hypertensive gastropathy

TIPS 

 Transjugular intrahepatic portosystemic stent

SBP 

 Spontaneous bacterial peritonitis

Introduction/background

In November 2004, the Austrian Society of Gastroenter-

ology and Hepatology (ÖGGH) held for the first time a 

consensus meeting on the definitions and treatment of 

portal hypertension and its complications in the Billroth-

Haus in Vienna, Austria (Billroth I-Meeting). This meet-

ing was preceded by a meeting of international experts on 

portal hypertension with some of the proponents of the 

Baveno consensus conferences (http://www.oeggh.at/

videos.asp). The consensus itself is based on the Baveno 

III consensus with regard to portal hypertensive bleed-

ing [

1

] and the suggestions of the International Ascites 

Club regarding the treatment of ascites [

2

]. Those state-

ments were modified by new knowledge derived from the 

recent literature and also by the current practice of medi-

cine as agreed upon by the participants of the consensus 

meeting. The section on TIPS-placement was based on 

the consensus statement of the Vienna TIPS Study Group 

(VTSG) [

3

].

In October 2011, the ÖGGH organized the second 

consensus meeting on portal hypertension and its com-

plications in Vienna (Billroth II-Meeting). The Billroth 

II-Guidelines on the definitions and treatment of portal 

hypertension and its complications take into account the 

developments of the last 7 years, including the Baveno-V 

update [

4

] and several key publications.

An effort was made to develop a practical guideline to 

everyday medical practice. In order to reduce the areas 

without specific recommendations for treatment to an 

absolute minimum, we included treatment recommen-

dations even in case of insufficient or contradictory data 

through consensus of the participating physicians. The 

evidence was graded according to a modified established 

grading system [

5

]:

Grade definition

I 

 Randomized controlled trials

II-1   Controlled trials without randomization

II-2   Cohort or case-control analytic studies

II-3   Multiple time series, dramatic uncontrolled 

experiments

III 

 Opinions of respected authorities, descriptive 

epidemiology

Criteria and definition of portal hypertension

1.  Clinically significant portal hypertension (CSPH) is 

defined as an increase of the hepatovenous pressure 

gradient (HVPG) to a threshold above 10 mmHg [

6

] (I).

2.   The presence of varices, variceal hemorrhage, and/or 

ascites (in the absence of significant cardiac, perito-

neal, or renal comorbidities) is indicative of the pres-

ence of CSPH (I).

3.   Measurement of the HVPG or endoscopic assessment 

of esophageal varices is sufficient for diagnosis of 

CSPH (I).

4.  The accuracy of noninvasive tests for diagnosis of 

CSPH (e.g., transient elastography, Doppler ultra-

sound, various indices containing dynamics in plate-

lets or other parameters) should be further evaluated. 

They are currently of limited use in daily clinical prac-

tice (III).

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