Abstract
The hepatic venous pressure gradient (HVPG) clearly reflects portal pressure in cirrhotic portal hypertension. Its relation with variceal bleeding has been well studied. We undertook to study the relation of HVPG to variceal size, Child's status, and etiology of cirrhosis. Patients with cirrhotic portal hypertension with esophageal varices underwent HVPG measurement as part of a prospective evaluation. One hundred seventy-six cirrhotics with varices (M:F, 140:36; mean age, 42.6 ± 13.4 years), 104 with CLD related to viral etiology, 40 with alcoholic liver disease, 26 cryptogenic with cirrhosis, and 6 with miscellaneous causes of CLD underwent HVPG measurement. The mean HVPG was lower in patients with small varices (n = 77; 14.6 ± 5.9 mm Hg) than in patients with large varices (n = 99; 19.2 ± 6.6 mm Hg; P < 0.01). In patients with large varices, the mean HVPG in bleeders (n = 37) was higher than in nonbleeders (n = 62) (21.7 ± 7.2 vs 17.9 ± 6.2 mm Hg; P < 0.01). The mean HVPG was significantly higher in Child's B (n = 97; 17.4 ± 6.9 mm Hg) and C (n = 56; 19.0 ± 5.7 mm Hg) compared to Child's A cirrhotics (n = 23; 12.2 ± 5.9 mm Hg; P < 0.01), and Child's C compared to Child's B cirrhotics (P = 0.05). HVPG was higher in alcoholic compared to nonalcoholic cirrhotics (20.8 ± 7.3 vs 16.4 ± 6.3 mm Hg; P < 0.05), but this was not significant in multivariate analysis. The HVPG was comparable between hepatitis B- and hepatitis C virus-related cirrhotics (P = 0.8). Cirrhotics with ascites had a higher HVPG than those without ascites (18.5 ± 5.6 vs 16.6 ± 7.6 mm Hg; P = 0.02). In multivariate analysis, only Child's status, size of varices, and variceal bleed predicted higher HVPG. HVPG is higher in cirrhotics with large varices and a history of bleed. There is a good correlation between HVPG and large varices, bleeder status, and ascites. A higher HVPG reflects more severe liver disease. The etiology of liver disease did not influence the portal pressure.
Similar content being viewed by others
References
Garcia-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE, Glickman M. (1985) Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology 5:419–424
Viallet A, Marleau D, Huet M, Martin F, Farley A, Villeneuve JP, Lavoie P (1975) Hemodynamic evaluation of patients with intrahepatic portal hypertension. Relationship between bleeding varices and the portohepatic gradient. Gastroenterology 69:1297–1300
de Franchis R (2000) Updating consensus in portal hypertension. Report of the Baveno III consensus workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol 33:846–852
Casado M, Bosch J, Garcia-Pagan JC, et al. (1998) Clinical events following transjugular intrahepatic portosystemic shunt: correlation with hemodynamic findings. Gastroenterology 114:1296–1303
Groszmann RJ, Bosch J, Grace ND, et al. (1990) Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Gastroenterology 99:1401–1407
Vorobioff J, Groszmann RJ, Picabea E, et al. (1996) Prognostic value of hepatic venous pressure gradient measurements in alcoholic cirrhosis: a 10-year prospective study. Gastroenterology 111:701–709
Escorsell A, Bordas JM, Castaneda B, Llach J, Garcia-Pagan JC, Rodes J, Bosch J (2000) Predictive value of the variceal pressure response to continued pharmacological therapy in patients with cirrhosis and portal hypertension. Hepatology 31:1061–1067
Villanueva C, Minana J, Ortiz J, et al. (2001) Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding. N Engl J Med 345:647–655
Rossle M, Siegerstetter V, Olschewski M, Ochs A, Berger E, Haag K (2001) How much reduction in portal pressure is necessary to prevent variceal rebleeding? A longitudinal study in 225 patients with transjugular intrahepatic portosystemic shunts. Am J Gastroenterol 96:3379–3383
Moitinho E, Escorsell A. Bandi JC, et al. (1999) Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology 117:626–631
Sanyal AJ, Genning C, Reddy KR, Wong F, Kowdley KV, Benner K, McCashland T, North American Study for the Treatment of Refractory Ascites Group (2003) The North American Study for the Treatment of Refractory Ascites. Gastroenterology 124:634–641
The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices (1988) Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med 319:983–989
Bellis L, Castellacci R, Montagnese F, Festuccia F, Corvisieri P, Puoti C (2003) Hepatic venous pressure gradient determination in patients with hepatitis C virus-related and alcoholic cirrhosis. Eur J Gastroenterol Hepatol 15:1085–1089
Perello A, Escorsell A, Bru C, Gilabert R, Moitinho E, Garcia-Pagan JC, Bosch J (1999) Wedged hepatic venous pressure adequately reflects portal pressure in hepatitis C virus-related cirrhosis. Hepatology 30:1393–1397
Valla D, Jiron MI, Poynard T, Lebrec D (1987) Failure of haemodynamic measurement to predict recurrent gastrointestinal bleeding incirrhotic patients receiving propranolol. J Hepatol 5:144–148
Conn HO (1967) Ammonia tolerance in the diagnosis of esophageal varices: a comparison of the endoscopic, radiologic and biochemical techniques. J Lab Clin Med 70:442–451
Lay CS, Tsai YT, Teg C, et al. (1997) Endoscopic variceal prophylaxis of first variceal bleeding in cirrhotic patients with high-risk esophageal varices. Hepatology 25:1346–1350
D'Amico G, Pagliaro L, Bosch J (1999) Pharmacological treatment of portal hypertension: an evidence-based approach. Semin Liver Dis 19:475–505
Merkel C, Marin R, Angeli P, Zanella P, Felder M, Bernardinello E, Cavallarin G, Bolognesi M, Donada C, Bellini B, Torboli P, Gatta A, Gruppo Triveneto per l'Ipertensione Portale (2004) A placebo-controlled clinical trial of nadolol in the prophylaxis of growth of small esophageal varices in cirrhosis. Gastroenterology 127:476–484
Sarin SK, Sethi KK, Nanda R (1987) Measurement and correlation of wedged hepatic, intrahepatic, intrasplenic and intravariceal pressures in patients with cirrhosis of liver and non-cirrhotic portal fibrosis. Gut 28:260–266
Thalheimer U, Mela M, Patch D, Burroughs AK (2004) Targeting portal pressure measurements; a critical reappraisal. Hepatology 39:286–290
Stanley AJ, Robinson I, Forrest EH, Jones AL, Hayes PC (1998) Hemodynamic parameters predicting variceal hemorrhage and survival in alcoholic cirrhosis. Q J Med 91:19–25
Abraldes JG, Tararitino I, Turnes J, Garcia-Pagan JC, Rodes J, Bosch J (2003) Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology 37:902–908
Burroughs AK, Groszman R, Bosch J, Grace N, Garcia-Tsao G, Patch D, Garcia-Pogan JCV, Dagher L (2002) Assessment of therapeutic benefit of antiviral therapy in chronic hepatitis C is hepatic venous pressure gradient a better end-point? Gut 50:425–427
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wadhawan, M., Dubey, S., Sharma, B.C. et al. Hepatic Venous Pressure Gradient in Cirrhosis: Correlation with the Size of Varices, Bleeding, Ascites, and Child's Status. Dig Dis Sci 51, 2264–2269 (2006). https://doi.org/10.1007/s10620-006-9310-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-006-9310-2