Objective
s: A reduction in hepatic venous pressure
gradient (HVPG) of ≥20% of baseline or to ≤12
mmHg (responders) is associated with a reduced
risk of first variceal bleeding. The aim of this study
was to evaluate whether this protective effect is
maintained in the long term and if it extends to other
portal hypertension complications. Methods: Seventyone
cirrhotic patients with esophageal varices and
without previous variceal bleeding who entered into a
program of prophylactic pharmacological therapy and
were followed for up to 8 yr were evaluated. All had
two separate HVPG measurements, at baseline and
after pharmacological therapy with propranolol±
isosorbide mononitrate. Results: Forty-six patients
were nonresponders and 25 were responders. Eightyear
cumulative probability of being free of
first variceal bleeding was higher in responders than
in nonresponders (90% vs 45%, p=0.026). The lack of
hemodynamic response and low platelet count were
the only independent predictors of first variceal
bleeding. Additionally, reduction of HVPG was
independently associated with a decreased risk of
spontaneous bacterial peritonitis (SBP) or bacteremia.
No significant differences in the development of
ascites, hepatic encephalopathy, or survival were
observed. Conclusions: The hemodynamic response
in cirrhotic patients is associated with a sustained
reduction in the risk of first variceal bleeding over
a long-term follow-up. Reduction of HVPG also
correlate with a reduced risk of SBP or bacteremia.
[Abstract reproduced by permisson of Am J
Gastroenterol 2006;101:506-512]
