Dear Juan Carlos
We have used spleen pulp pressure measurement as a mean to determine the non-cirrotoc portal hypertension, which must be found in your patient.
Did you perform a liver biopsy and did it reveal any changes. Despite the normal elstography there may be changes in the liver suggesting pre-sinusoidal portal hypertension. Has sarcoidosis been ruled out?
Are liver enzymes normal?
For treatment long-acting soamtostatin analogue may help – though evidence is scarce?
Is the patient European? No schistosomiasis?
Looking forward to have the diagnosis