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HVPG measurement: is it mandatory for the management of portal hypertension?—Con
Author(s) -
BOYER THOMAS D
Publication year - 2004
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2004.03670.x
Subject(s) - medicine , portal hypertension , bleed , portal venous pressure , varices , hemodynamics , intensive care medicine , population , randomized controlled trial , surgery , cirrhosis , environmental health
Complications of portal hypertension are common in the cirrhotic, and bleeding varices are a significant cause of morbidity and mortality in this population. We currently can identify the patients at greatest risk for bleeding by the endoscopic appearance of the varices and we know that once a patient bleeds, rebleeding is almost inevitable. Thus, both groups of patients are targets for preventative therapy. Currently, non‐selective beta‐blockers are used to reduce the risk of bleeding in both types of patients but many patients fail this form of therapy and bleed or rebleed. Recent studies have shown that patients who fail to have a hemodynamic response to beta blocker therapy are most likely to fail therapy and it has been suggested that measurement of the hepatic vein pressure gradient (HVPG) be used in the routine management of this group of patients. Unfortunately, there are many unresolved issues as to the utility of the hemodynamic response in the management of cirrhotics. Outside of academic medical centers, the ability to measure pressures accurately is limited and thus significant training would be required before the test can have widespread acceptance. More importantly, it has not been shown in prospective randomized trials that using the hemodynamic response to define the therapeutic approach is any better than the current approach of giving everyone beta‐blockers and using variceal band ligation in those who bleed or rebleed. Pending the completion and publishing of these types of controlled trials, measurement of the HVPG will remain of academic interest only.