Portal Hypertension (PH) is the commonest cause of upper gastrointestinal
bleeding in children. Most Indian studies have highlighted extrahepatic portal venous obstruction (EHPVO) as the major cause of PH in children. As there is paucity of data from the eastern part of the country we decided to study the major causes of PH in children in this region and to ascertain the efficacy of
sclerotherapy for its management. Fifty children aged 14 months to 10 years with PH were studied from April 1990 to April 1995. Thorough examination and relevant investigations showed non-cirrhotic portal
fibrosis (NCPF) in 24 (48%), EHPVO in 18 (36%) and
cirrhosis of liver in 8 (16%) children. Forty six children had
hematemesis and melaena of whom endoscopic
sclerotherapy (EST) was done in 45 cases. One child having type 2
gastric varices was referred for surgery. Following eradication of
varices the patients were followed-up at 3 monthly intervals. Number of sittings of
sclerotherapy required for obliteration of
varices was 5.9 +/- 1.6. A variceal state was achieved in 35 (78%) cases and
varices were reduced to Grade I in 6 cases (13%). Two cases underwent surgery for EST failure. One patient of
cirrhosis died within two weeks of
bleeding episode due to hepatic encephalpathy. Rebleeding (13%) and recurrences (13%) were noted during the follow-up period. Retrosternal discomfort (22%),
dysphagia (22%),
stricture (13%), oesophageal ulceration (13%) and
fever (11%) were the complications noted but these could be managed conservatively. The present study highlights that NCPF is an important cause of PH in eastern India. EST is useful in controlling variceal
bleeding in children irrespective of their aetiology.