Skip to main content

Portal Hypertension

  • Chapter
  • First Online:
Liver Disorders

Abstract

Many dreaded complications of cirrhosis are directly attributed to the development of portal hypertension, leading to significant morbidity and mortality. The understanding and early recognition of this condition is of extreme importance and may have prognostic implications. The diagnosis of portal hypertension portrays a challenge to clinicians and the search for noninvasive methods remains a prominent area of research. This chapter will review the diagnosis and recent advancements in the field of portal hypertension and also cover its definition, pathophysiology, and other causes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gadano A, Hadengue A, Vachiery F, Moreau R, Sogni P, Soupison T, et al. Relationship between hepatic blood flow, liver tests, haemodynamic values and clinical characteristics in patients with chronic liver disease. J Gastroenterol Hepatol. 1997;12:167–71.

    Article  CAS  PubMed  Google Scholar 

  2. Bhathal PS, Grossman HJ. Reduction of the increased portal vascular resistance of the isolated perfused cirrhotic rat liver by vasodilators. J Hepatol. 1985;1:325–37.

    Article  CAS  PubMed  Google Scholar 

  3. Kowalski HJ, Abelmann WH. The cardiac output at rest in Laennec’s cirrhosis. J Clin Invest. 1953;32:1025–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Lebrec D, Sogni P, Vilgrain V. Evaluation of patients with portal hypertension. Baillieres Clin Gastroenterol. 1997;11:221–41.

    Article  CAS  PubMed  Google Scholar 

  5. Lunderquist A, Vang J. Transhepatic catheterization and obliteration of the coronary vein in patients with portal hypertension and esophageal varices. N Engl J Med. 1974;291:646–9.

    Article  CAS  PubMed  Google Scholar 

  6. Perello A, Escorsell A, Bru C, Gilabert R, Moitinho E, Garcia-Pagan JC, et al. Wedged hepatic venous pressure adequately reflects portal pressure in hepatitis C virus-related cirrhosis. Hepatology. 1999;30:1393–7.

    Article  CAS  PubMed  Google Scholar 

  7. Iwao T, Toyonaga A, Ikegami M, Sumino M, Oho K, Sakaki M, et al. Wedged hepatic venous pressure reflects portal venous pressure during vasoactive drug administration in nonalcoholic cirrhosis. Dig Dis Sci. 1994;39:2439–44.

    Article  CAS  PubMed  Google Scholar 

  8. Thalheimer U, Leandro G, Samonakis DN, Triantos CK, Patch D, Burroughs AK. Assessment of the agreement between wedge hepatic vein pressure and portal vein pressure in cirrhotic patients. Dig Liver Dis. 2005;37:601–8.

    Article  CAS  PubMed  Google Scholar 

  9. Groszmann RJ, Wongcharatrawee S. The hepatic venous pressure gradient: anything worth doing should be done right. Hepatology. 2004;39:280–2.

    Article  PubMed  Google Scholar 

  10. Bosch J, Abraldes JG, Berzigotti A, Garcia-Pagan JC. The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol. 2009;6:573–82.

    Article  CAS  PubMed  Google Scholar 

  11. Groszmann RJ, Bosch J, Grace ND, Conn HO, Garcia-Tsao G, Navasa M, et al. Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Gastroenterology. 1990;99:1401–7.

    Article  CAS  PubMed  Google Scholar 

  12. Garcia-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE, Glickman M. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985;5:419–24.

    Article  CAS  PubMed  Google Scholar 

  13. Merkel C, Bolognesi M, Bellon S, Zuin R, Noventa F, Finucci G, et al. Prognostic usefulness of hepatic vein catheterization in patients with cirrhosis and esophageal varices. Gastroenterology. 1992;102:973–9.

    Article  CAS  PubMed  Google Scholar 

  14. Lebrec D, De Fleury P, Rueff B, Nahum H, Benhamou JP. Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis. Gastroenterology. 1980;79:1139–44.

    CAS  PubMed  Google Scholar 

  15. Stanley AJ, Robinson I, Forrest EH, Jones AL, Hayes PC. Haemodynamic parameters predicting variceal haemorrhage and survival in alcoholic cirrhosis. QJM. 1998;91:19–25.

    Article  CAS  PubMed  Google Scholar 

  16. Moitinho E, Escorsell A, Bandi JC, Salmeron JM, Garcia-Pagan JC, Rodes J, et al. Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology. 1999;117:626–31.

    Article  CAS  PubMed  Google Scholar 

  17. Ripoll C, Banares R, Rincon D, Catalina MV, Lo Iacono O, Salcedo M, et al. Influence of hepatic venous pressure gradient on the prediction of survival of patients with cirrhosis in the MELD Era. Hepatology. 2005;42:793–801.

    Article  PubMed  Google Scholar 

  18. Bruix J, Castells A, Bosch J, Feu F, Fuster J, Garcia-Pagan JC, et al. Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology. 1996;111:1018–22.

    Article  CAS  PubMed  Google Scholar 

  19. Poynard T, Degott C, Munoz C, Lebrec D. Relationship between degree of portal hypertension and liver histologic lesions in patients with alcoholic cirrhosis. Effect of acute alcoholic hepatitis on portal hypertension. Dig Dis Sci. 1987;32:337–43.

    Article  CAS  PubMed  Google Scholar 

  20. Sen S, Mookerjee RP, Cheshire LM, Davies NA, Williams R, Jalan R. Albumin dialysis reduces portal pressure acutely in patients with severe alcoholic hepatitis. J Hepatol. 2005;43:142–8.

    Article  CAS  PubMed  Google Scholar 

  21. Rincon D, Lo Iacono O, Ripoll C, Gomez-Camarero J, Salcedo M, Catalina MV, et al. Prognostic value of hepatic venous pressure gradient for in-hospital mortality of patients with severe acute alcoholic hepatitis. Aliment Pharmacol Ther. 2007;25:841–8.

    Article  CAS  PubMed  Google Scholar 

  22. Ripoll C, Groszmann RJ, Garcia-Tsao G, Bosch J, Grace N, Burroughs A, et al. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol. 2009;50:923–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lebrec D, Poynard T, Bernuau J, Bercoff E, Nouel O, Capron JP, et al. A randomized controlled study of propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: a final report. Hepatology. 1984;4:355–8.

    Article  CAS  PubMed  Google Scholar 

  24. Lebrec D, Hillon P, Munoz C, Goldfarb G, Nouel O, Benhamou JP. The effect of propranolol on portal hypertension in patients with cirrhosis: a hemodynamic study. Hepatology. 1982;2:523–7.

    Article  CAS  PubMed  Google Scholar 

  25. Feu F, Garcia-Pagan JC, Bosch J, Luca A, Teres J, Escorsell A, et al. Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis. Lancet. 1995;346:1056–9.

    Article  CAS  PubMed  Google Scholar 

  26. Vorobioff J, Groszmann RJ, Picabea E, Gamen M, Villavicencio R, Bordato J, et al. Prognostic value of hepatic venous pressure gradient measurements in alcoholic cirrhosis: a 10-year prospective study. Gastroenterology. 1996;111:701–9.

    Article  CAS  PubMed  Google Scholar 

  27. Abraldes JG, Tarantino I, Turnes J, Garcia-Pagan JC, Rodes J, Bosch J. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology. 2003;37:902–8.

    Article  PubMed  Google Scholar 

  28. Villanueva C, Lopez-Balaguer JM, Aracil C, Kolle L, Gonzalez B, Minana J, et al. Maintenance of hemodynamic response to treatment for portal hypertension and influence on complications of cirrhosis. J Hepatol. 2004;40:757–65.

    Article  PubMed  Google Scholar 

  29. Merkel C, Bolognesi M, Sacerdoti D, Bombonato G, Bellini B, Bighin R, et al. The hemodynamic response to medical treatment of portal hypertension as a predictor of clinical effectiveness in the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology. 2000;32:930–4.

    Article  CAS  PubMed  Google Scholar 

  30. Villanueva C, Minana J, Ortiz J, Gallego A, Soriano G, Torras X, et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding. N Engl J Med. 2001;345:647–55.

    Article  CAS  PubMed  Google Scholar 

  31. Hicken BL, Sharara AI, Abrams GA, Eloubeidi M, Fallon MB, Arguedas MR. Hepatic venous pressure gradient measurements to assess response to primary prophylaxis in patients with cirrhosis: a decision analytical study. Aliment Pharmacol Ther. 2003;17:145–53.

    Article  CAS  PubMed  Google Scholar 

  32. de Franchis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;53:762–8.

    Article  PubMed  Google Scholar 

  33. de Bruyn G, Graviss EA. A systematic review of the diagnostic accuracy of physical examination for the detection of cirrhosis. BMC Med Inform Decis Mak. 2001;1:6.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Berzigotti A, Gilabert R, Abraldes JG, Nicolau C, Bru C, Bosch J, et al. Noninvasive prediction of clinically significant portal hypertension and esophageal varices in patients with compensated liver cirrhosis. Am J Gastroenterol. 2008;103:1159–67.

    Article  CAS  PubMed  Google Scholar 

  35. Abraldes JG, Villanueva C, Banares R, Aracil C, Catalina MV, Garci APJC, et al. Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy. J Hepatol. 2008;48:229–36.

    Article  PubMed  Google Scholar 

  36. Zaman A, Hapke R, Flora K, Rosen HR, Benner K. Factors predicting the presence of esophageal or gastric varices in patients with advanced liver disease. Am J Gastroenterol. 1999;94:3292–6.

    Article  CAS  PubMed  Google Scholar 

  37. Verma V, Sarin SK, Sharma P, Kumar A. Correlation of aspartate aminotransferase/platelet ratio index with hepatic venous pressure gradient in cirrhosis. United European Gastroenterol J. 2014;2:226–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Abdelmoneim SS, Talwalkar J, Sethi S, Kamath P, Fathalla MM, Kipp BR, et al. A prospective pilot study of circulating endothelial cells as a potential new biomarker in portal hypertension. Liver Int. 2010;30:191–7.

    Article  CAS  PubMed  Google Scholar 

  39. Sethi S, Simonetto DA, Abdelmoneim SS, Campion MB, Kaloiani I, Clayton AC, et al. Comparison of circulating endothelial cell/platelet count ratio to aspartate transaminase/platelet ratio index for identifying patients with cirrhosis. J Clin Exp Hepatol. 2012;2:19–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Kondo M, Miszputen SJ, Leite-mor MM, Parise ER. The predictive value of serum laminin for the risk of variceal bleeding related to portal pressure levels. Hepatogastroenterology. 1995;42:542–5.

    CAS  PubMed  Google Scholar 

  41. Kropf J, Gressner AM, Tittor W. Logistic-regression model for assessing portal hypertension by measuring hyaluronic acid (hyaluronan) and laminin in serum. Clin Chem. 1991;37:30–5.

    CAS  PubMed  Google Scholar 

  42. Thabut D, Imbert-Bismut F, Cazals-Hatem D, Messous D, Muntenau M, Valla DC, et al. Relationship between the Fibrotest and portal hypertension in patients with liver disease. Aliment Pharmacol Ther. 2007;26:359–68.

    Article  CAS  PubMed  Google Scholar 

  43. Vilgrain V, Lebrec D, Menu Y, Scherrer A, Nahum H. Comparison between ultrasonographic signs and the degree of portal hypertension in patients with cirrhosis. Gastrointest Radiol. 1990;15:218–22.

    Article  CAS  PubMed  Google Scholar 

  44. Berzigotti A, Seijo S, Arena U, Abraldes JG, Vizzutti F, Garcia-Pagan JC, et al. Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology. 2013;144:102–111.e1.

    Article  PubMed  Google Scholar 

  45. Castera L, Pinzani M, Bosch J. Non invasive evaluation of portal hypertension using transient elastography. J Hepatol. 2012;56:696–703.

    Article  PubMed  Google Scholar 

  46. Simonetto DA, Yang HY, Yin M, de Assuncao TM, Kwon JH, Hilscher M, et al. Chronic passive venous congestion drives hepatic fibrogenesis via sinusoidal thrombosis and mechanical forces. Hepatology. 2015;61:648–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Carrion JA, Navasa M, Bosch J, Bruguera M, Gilabert R, Forns X. Transient elastography for diagnosis of advanced fibrosis and portal hypertension in patients with hepatitis C recurrence after liver transplantation. Liver Transpl. 2006;12:1791–8.

    Article  PubMed  Google Scholar 

  48. Vizzutti F, Arena U, Romanelli RG, Rega L, Foschi M, Colagrande S, et al. Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology. 2007;45:1290–7.

    Article  PubMed  Google Scholar 

  49. Shi KQ, Fan YC, Pan ZZ, Lin XF, Liu WY, Chen YP, et al. Transient elastography: a meta-analysis of diagnostic accuracy in evaluation of portal hypertension in chronic liver disease. Liver Int. 2013;33:62–71.

    Article  PubMed  Google Scholar 

  50. Castera L, Foucher J, Bernard PH, Carvalho F, Allaix D, Merrouche W, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology. 2010;51:828–35.

    PubMed  Google Scholar 

  51. Yin M, Talwalkar JA, Glaser KJ, Manduca A, Grimm RC, Rossman PJ, et al. Assessment of hepatic fibrosis with magnetic resonance elastography. Clin Gastroenterol Hepatol. 2007;5:1207–1213.e2.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Ronot M, Lambert S, Elkrief L, Doblas S, Rautou PE, Castera L, et al. Assessment of portal hypertension and high-risk oesophageal varices with liver and spleen three-dimensional multifrequency MR elastography in liver cirrhosis. Eur Radiol. 2014;24:1394–402.

    PubMed  Google Scholar 

  53. Colecchia A, Montrone L, Scaioli E, Bacchi-Reggiani ML, Colli A, Casazza G, et al. Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis. Gastroenterology. 2012;143:646–54.

    Article  PubMed  Google Scholar 

  54. Valla DC, Condat B. Portal vein thrombosis in adults: pathophysiology, pathogenesis and management. J Hepatol. 2000;32:865–71.

    Article  CAS  PubMed  Google Scholar 

  55. DeLeve LD, Valla DC, Garcia-Tsao G. Vascular disorders of the liver. Hepatology. 2009;49:1729–64.

    Article  CAS  PubMed  Google Scholar 

  56. Schouten JN, Garcia-Pagan JC, Valla DC, Janssen HL. Idiopathic noncirrhotic portal hypertension. Hepatology. 2011;54:1071–81.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge the American Association for the Study of Liver Diseases Foundation for the funding support through the Advanced/Transplant Hepatology Fellowship Award.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vijay H. Shah M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Simonetto, D.A., Shah, V.H. (2017). Portal Hypertension. In: Saeian, K., Shaker, R. (eds) Liver Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-30103-7_27

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-30103-7_27

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-30101-3

  • Online ISBN: 978-3-319-30103-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics