Abstract
Many of the clinical complications of cirrhosis are the direct consequences of the elevation of portal venous pressure (PVP). Portal hypertension is defined as a PVP of greater than the normal 5–10 mmHg. The degree of portal hypertension has been shown to correlate with the severity of liver disease, both functionally1 and histologically2, 3. However, direct portal venous measurement is invasive and cannot be routinely performed. As a surrogate, hepatic venous pressure gradient (HVPG) has been widely accepted as a measurement for PVP. The ease and safety of HVPG measurement has made it a valuable tool not only in the research arena, but also more and more in clinical practice.
Fact: An assertion, statement, or information containing or purporting to contain something having objective reality Webster’s Third New International Dictionary
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References
Braillon A, Cales P, Valla D, Gaudy D, Geoffroy P, Lebrec D. Inftuenece of the degree of liver failure on systemic and splanchnic hemodynamics and on response to propranolol in patients with cirrhosis. Gut. 1986:27:1204–9.
Krogsgaard K, Gluud C, Henriksen JH, Christoffersen P. Correlation between liver morphology and portal pressure in alcoholic liver disease. Hepatology. 1984:4:699–703.
Picchiotti R, Mingazzini PL, Scucchi L et al. Correlations between sinusoidal pressure and liver morphology in cirrhosis. J Hepatol. 1994:20:364–9.
Hallion L, Francois-Frank CA. Recherches experimentales executees a I’aide d’um novel appareil volumetrique sur I’innervation vaso-motrice de l’intestin. Arch Physiol Norm Pathol. 1896:8:493–508.
Thompson WP, Caughey JL, Whipple AO et al. Splenic vein pressure and congestive splenomegaly (Banty’s syndrome). J Clin Invest. 1937:16:571.
Myers JD, Taylor WJ. An estimation of PVP by occlusive catheterization of a hepatic venule. J Clin Invest. 1991:30:662–3.
Groszmann RJ, Wongcharatrawee S. The hepatic venous pressure gradient: anything worth doing should be done right. Hepatology. 2004:39:280–2.
Groszmann RJ, Glickman MC, Blei AT, Storer E, Conn HO. Wedged and free hepatic venous pressure measured with a balloon catheter. Gastroenterology. 1979:76:253–8.
Bosch J, Mastai R, Kravetz D, Navasa M. Rodes J. Hemodynamic evaluation of patients with portal hypertension. Semin Liver Dis. 1986:6:309–17.
Seinlauf AF, García-Tsao G, Gupta T, Dickey K, Zakko MF, Groszmann RJ. Low-dose midazolam sedation: an option for patients undergoing serial hepatic venous pressure measurements. Hepatology. 1999:29:1070–3.
Groszmann RJ, de Franchis R. Portal hypertension. In: Schiff ER, Sorrell MF, Maddrey W, editors. Schiff’s Diseases of the Liver. Philadelphia: Lippincott-Raven, 1999:387–442.
Boyer TD, Triger DR, Horisawa M, Redeker AG, Reynolds TB. Direct transhepatic measurement of portal vein pressure using a thin needle: comparison with wedged hepatic venous pressure. Gastroenterology. 1977:72:584–9.
Groszmann RJ, Atterbury CE. Clinical applications of the measurement of portal venous pressure. J Clin Gastroenterol. 1980:2:379–86.
Pomier-Layrargues G, Kusielewicz D, Willems B et al. Presinusoidal portal hypertension in non-alcoholic cirrhosis. Hepatology. 1985:5:415–18.
Perello A, Escorsell A, Bru C et al. Wedged hepatic venous pressure adequately reflects portal pressure in hepatitis C virus-related cirrhosis. Hepatology. 1999:30:1393–7.
Deplano A, Migaleddu V, Pischedda A et al. Portohepatic gradient and portal hemodynamics in patients with cirrhosis due to hepatitis C virus infection. Dig Dis Sci. 1999:44:155–62.
Loureiro-Silva MR, Cadelina GW, Groszmann RJ. Deficit in nitric oxide production in cirrhotic rat livers is located in the sinusoidal and postsinusoidal areas. Am J Physiol Gastrointest Liver Physiol. 2003:284:G567–74.
Infante-Rivard C, Esnaola S, Villeneuve JP. Clinical and statistical validity of conventional prognostic factors in predicting short-term survival among cirrhotics. Hepatology. 1987:7:660–4.
Arroyo V, Bosch J, Gaya-Beltran J et al. Plasma renin activity and urinary sodium excretion as prognostic indicators in nonazotemic cirrhosis with ascites. Ann Intern Med. 1981:94: 198–201.
Vinel JP, Cassigneul J, Louis A, Levade M, Pascal JP. Clinical and prognostic significance of portohepatic gradient in patients with cirhosis. Surg Gynecol Ohstet. 1982:155:347–52.
Vinel JP, Cassigneul J, Levade M, Voigt JJ, Pascal JP. Assessment of short-term prognosis after variceal bleeding in patients with alcoholic cirrhosis by early measurement of portohepatic gradient. Hepatology. 1986:6:116–17.
Gluud C, Henriksen JH, Nielsen G. Prognostic indicators in alcoholic cirrhotic men. Hepatology. 1988:8:222–7.
Tage-Jensen U, Henriksen JH, Christensen E, Widding A, Ring-Larsen H, Christensen NJ. Plasma catecholamine level and portal venous pressure as guides to prognosis in patients with cirrhosis. J Hepatol. 1988:6:350–8.
Groszmann RJ, Bosch J, Grace N et al. Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Gastroenterology. 1990:99:1401–7.
Merkel C, Bolognesi M, Bellon S et al. Prognostic usefulness of hepatic vein catheterization in patients with cirrhosis and esophageal varices. Gastroenterology. 1992:102:973–9.
Vorobioff J, Groszmann RJ, Picabea E et al. Prognostic value of hepatic venous pressure measurement in alcoholic cirrhosis: A ten year prospective study. Gastroenterology. 1996:111:701–9.
Villanueva C, Aracil C, Lopez-Balaguer JM, Balanzo J. Nadolol plus isosorbide mononitrate compared with sclerotherapy for the prevention of variceal rcbleeding. N Engl J Med. 1996:334:1624–9.
Patch D, Armonis A, Sabin C et al. Single portal pressure measurement predicts survival in cirrhotic patients with recent bleeding. Gut. 1999:44:264–9.
Moitinho E, Escorsell A, Bandi JC et al. Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology. 1999:117:626–31.
Abraldes JG, Tarantino I, Turnes J Garcia-Pagan JC, Rodes J, Bosch J. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology. 2003:37:902–8.
Urbain D, Muls V, Makhoul E, Jeghers O, Thys O, Ham HR. Prognostic significance of hepatic venous pressure gradient in medically treated alcoholic cirrhosis: comparison to aminopyrine breath test. Am J Gastroenterol. 1993:88:856–9.
Pomier-Layrargues G, Villeneuve JP, Willems B, Huet PM, Marleau D. Systemic and hepatic hemodynamics after variceal hemorrhage: effects of propranolol and placebo. Gastroenterology. 1987:93:1218–24.
Groszmann, RJ, Garcia-Tsao G, Makuch R et al. Multicenter randomized placebo-controlled trial of non-selective beta-blockers in the prevention of the complications of portal hypertension: final results and identification of a predictive factor. Hepatology. 2003:38 (Suppl. 1):206A (abstract).
García-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985:5:419–24.
Rigau J, Bosch J, Bordas JM et al. Endoscopic measurement of variceal pressure in cirrhosis: correlation with portal pressure and variceal hemorrhage. Gastroenterology. 1989:96: 873–80.
Viallet A, Marleau D, Huet M et al. Hemodynamic evaluation of patients with intrahepatic portal hypertension. Relationship between bleeding varices and the porto hepatic gradient. Gastroenterology. 1975:69: 1297–300.
Christensen U, Sorensen TI, Jensen LI, Aagaard J, Burcharth F. The free portal pressure in awake patients with and without cirrhosis of the liver. Liver. 1983:3:147–50.
Viola C, Bosch J, Mastai R et al. Prognostic value of measurements of portal pressure in patients with cirrhosis. J Hepatol. 1987:5(Suppl. 1):S71 (abstract).
Vlavianos P, Gimson AES, Hayllar K et al. Prognostic significance of systemic and portal hemodynamic parameters in patients with cirrosis and previous variceal bleeding. Gut. 1990:31:A592 (abstract).
Lebrec D, De Fleury P, Rueff B, Nahum H, Benhamou JP. Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis. Gastroenterology. 1980:79:1139–44.
Adamson RJ, Butt K, Dennis CR et al. Prognostic significance of portal pressure in patients with bleeding esophageal varices. Surg Gynecol Obstet. 1977:145:353–6.
Ready JB, Robertson AD, Goff JS, Rector WG Jr. Assessment of the risk of bleeding from esophageal varices by continuous monitoring of portal pressure. Gastroenterology. 1991:100:1403–10.
Westaby D, Polson RJ, Gimson AE, Hayes PC, Hayllar K, Williams R. A controlled trial of oral propranolol compared with injection sclerotherapy for the long-term management of variceal bleeding. Hepatology. 1990:11:353–9.
Villanueva C, Ortiz J, Miñana J et al. Somatostatin treatment and risk stratification by continuous portal pressure monitoring during acute variceal bleeding. Gastroenterology. 2001:121:110–17.
Leevy CM, Zinke M, Baber J, Chey WY. Observations on the influence of medical therapy on portal hypertension in hepatic cirrhosis. Ann Intern Med. 1958:49:837–51.
Reynolds TB, Geller HM, Kuzma OT, Redeker AG. Spontaneous decrease in portal pressure with clinical improvement in cirrhosis. N Engl J Med. 1960;263:734–9.
D’Amico G, García-Tsao G, Calès P et al. Diagnosis of portal hypertension. How and when? In: de Franchis R, editor. Portal Hypertension. III. Proceedings of the Third Baveno International Consensus Workshop on Definitions, Methodology and Therapeutic Strategies. Oxford: Blackwell Science, 2001:36–63.
Morali GA, Sniderman KW, Deitel KM et al. Is sinusoidal portal hypertension a necessary factor for the development of hepatic ascites? J Hepatol. 1992:16:249–50.
Rector WG Jr. Portal hypertension: a permissive factor only in the development of ascites and variceal bleeding. Liver. 1986:6:221–6.
Bosch J, Mastai R, Kravetz D, Navasa M, Rodes J. Hemodynamic evaluation of the patient with portal hypertension. Semin Liver Dis. 1986:6:309 17.
Feu F, García-Pagán JC, Bosch J et al. Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal hemorrhage in patients with cirrhosis. Lancet. 1995:346:1056–9.
McCormick PA, Patch D, Greenslade L, Chin J, McIntyre N, Burroughs AK. Clinical vs hemodynamic response to drugs in portal hypertension. J Hepatol. 1998:28:1015–19.
Villanueva C, Minana J, Ortiz J et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding. N Engl J Med. 2001:345:647–55.
Merkel C, Bolognesi M, Sacerdoti D et al. The hemodynamic response to medical treatment of portal hypertension as a predictor of clinical effectiveness in the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology. 2000:32:930–4.
Bureau C, Péron JM, Alric L et al. “A la carte” treatment of portal hypertension: adapting medical therapy to hemodynamic response for the prevention of bleeding. Hepatology. 2002:36:1361–6.
Patch D, Sabin CA, Goulis J et al. A randomized, controlled trial of medical therapy versus endoscopic ligation for the prevention of variceal rebleeding in patients with cirrhosis. Gastroenterology. 2002:123:1013–19.
Groszmann RJ, Garcïa-Tsao G. Endoscopic variceal banding vs pharmacological therapy for the prevention of recurrent variceal hemorrhage: what makes the difference? Gastroenterology. 2002:123:1388–91.
Burroughs AK, Groszmann RJ, Bosch J et al. Assessment of therapeutic benefit of antiviral therapy in chronic hepatitis C: is hepatic venous pressure a better end point? Gut. 2002:50:425–7.
Friedman LS, Maddrey WC. Surgery in the patient with liver disease. Med Clin N Am. 1987:71:453–76.
Bruix J, Castells A, Bosch J et al. Surgical resection of hepatocellular carcinoma in cirrhotic patients. Prognostic value of preoperative portal pressure. Gastroenterology. 1996: 111:1018–22.
Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology. 1999:30:1434–40.
Lovet JM, Bruix J, Fuster J et al. Liver transplantation for small hepatocellular carcinoma: the tumor-node-metastasis classification does not have prognosis power. Hepatology. 1998:27: 1572–7.
Mazzaferro V, Regalia E, Doci R et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996:334:693–9.
Bismuth H, Chiche L, Adam R, Castaing D, Diamond T, Dennison A. Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg. 1993: 218:145–51.
Groszmann RJ. The hepatic venous pressure gradient: has the time arrived for its application in clinical practice? Hepatology. 1996:24:739–41.
Thalheimer U, Mela M, Patch D, Burroughs AK. Monitoring target reduction in hepatic venous pressure gradient during pharmacological therapy of portal hypertension: a close look at the evidence. Gut. 2004:53:143–8.
Huet PM, Pomier-Layrargues G. The hepatic venous pressure gradient: “remixed and revisited”. Hepatology. 2004:39:295–8.
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Vorobioff, J.D., Abraldes, J.G., Groszmann, R.J. (2004). Hepatic venous pressure gradient: the facts. In: Groszmann, R.J., Bosch, J. (eds) Portal Hypertension in the 21st Century. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-1042-9_32
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DOI: https://doi.org/10.1007/978-94-007-1042-9_32
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