Korean J Hepatol > Volume 12(3); 2006 > Article
The Korean Journal of Hepatology 2006;12(3): 464-468.
The Korean Journal of Prevention of Variceal Bleeding and Measurement of Hepatic Vein Pressure Gradient
Kwang Hee Youn , Dong Joon Kim
Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Korea
Objectives: 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.
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.
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.
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]
KeyWords: Variceal bleeding; Hepatic vein pressure gradient; Prevention; beta-Blocker

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