Should we routinely measure portal pressure in patients with cirrhosis, using hepatic venous pressure gradient (HVPG) as guidance for prophylaxis and treatment of bleeding and re-bleeding? Yes!
Portal hypertension is key to the natural history of cirrhosis. The standard way to assess portal hypertension is the hepatic venous pressure gradient (HVPG). HVPG has been convincingly shown to be a strong predictor of variceal bleeding and survival. In addition, it has been shown to predict other portal hypertension-related clinical events, to include fluid retention and hepatic encephalopathy. Finally, HVPG is the only suitable tool to assess the response of portal hypertension to medical treatment. Thus, although not necessarily easy to measure, HVPG provides the clinician with information which is prognostically crucial and otherwise unobtainable.
Hepatic Haemodynamics Laboratory and Clinica Medica 5, Department of Clinical and Experimental Medicine, University of Padua, Italy. carlo.merkel@unipd.it
Carlo
C
Merkel
Sara
S
Montagnese
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006470:Hemorrhage / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D017082:Portal Pressure; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists