Evaluation and treatment of portal hypertension
Authors:
doc. CSc. Mudr Radan Brůha; MUDr. CSc. Jaromír Petrtýl
Authors place of work:
IV. interní klinika 1. LF UK a VFN: U Nemocnice, 128 08 Praha
2
Published in the journal:
Čas. Lék. čes. 2016; 155: 76-80
Category:
Review Articles
Summary
Liver cirrhosis is a serious disease shortening the life expectancy. Unavoidable consequence of cirrhosis is portal hypertension, which usually limits the prognosis by its complications. Portal hypertension is a prognostic factor for cirrhosis decompensation, variceal bleeding and even the mortality in cirrhotic patients. In the evaluation of portal hypertension hepatic venous pressure gradient (HVPG) measurement is used.
Measurement of HVPG is used in clinical praxis in these situations:
- diagnosis of portal hypertension,
- evaluation of prognosis of patients with cirrhosis,
- monitoring the treatment efficacy in the prevention of variceal bleeding,
- management of acute variceal bleeding.
Decrease of HVPG below 12 mmHg or at least for more than 20% of initial value in the treatment by beta-blockers is associated with the lower risk of bleeding from varices or other complications. HVPG above 20 mm Hg is associated with the high risk of early rebleeding from varices and can discriminate those patients profiting from early TIPS.
HVPG measurement is an invasive, but simple, reproducible and safe catheterization technique with minimal complication rate. The most frequent complication could be incorrect assessment of obtained values. HVPG measurement should be a routine technique in centers specialized to liver diseases.
Keywords:
cirrhosis; HVPG (hepatic venous pressure gradient); portal hypertension; variceal bleeding
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