Importance of portosystemic pressure gradient measurement (HVPG) in patients with liver cirrhosis


Authors: R. Brůha;  J. Petrtýl
Authors‘ workplace: IV. interní klinika – klinika gastroenterologie a hepatologie, VFN a 1. LF UK v Praze
Published in: Gastroent Hepatol 2011; 65(3): 143-148
Category: Hepatology: Rewiev Article

Overview

Liver cirrhosis is a serious disease shortening life expectancy. An 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 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 the following situations: diagnosis of portal hypertension; evaluation of the prognosis of patients with cirrhosis; monitoring the treatment efficacy in the prevention of variceal bleeding; management of acute variceal bleeding. Decrease of HVPG under 12 mm Hg or at least by 20% from the initial value in the treatment with beta-blockers is associated with a lower risk of bleeding from varices or other complications. HVPG over 20 mm Hg is associated with a high risk of early rebleeding from esophageal varices and can influence decisions on early TIPS. HVPG measurement is an invasive, but simple, reproducible and safe catheterization technique with minimum complication rate. Broadly speaking, the most frequent complication is incorrect interpretation of obtained values. HVPG measurement should be a routine technique in centres specializing in the treatment of patients with liver diseases.

Key words:
cirrhosis – hepatic venous pressure gradient – variceal bleeding – portal hypertension


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Paediatric gastroenterology Gastroenterology and hepatology Surgery

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