Noninvasive assessment of portal hypertension in patients with cirrhosis

• Published in: Hepatology (Baltimore, Md.) Vol. 53; no. 2; pp. 683 - 694
• Main Authors: Thabut, Dominique, Moreau, Richard, Lebrec, Didier
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-02-2011; Wiley; Wiley Subscription Services, Inc
• Subjects: Biological and medical sciences; Biomarkers - blood; Esophageal and Gastric Varices - diagnostic imaging; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - pathology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatology; Humans; Hypertension; Hypertension, Portal - complications; Hypertension, Portal - diagnosis; Hypertension, Portal - physiopathology; Liver cirrhosis; Liver Cirrhosis - blood; Liver Cirrhosis - complications; Liver Cirrhosis - pathology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Methods; Other diseases. Semiology; Radiography; Severity of Illness Index; Vascular Resistance - physiology; Vascular disease; Human; Cirrhosis; Portal circulation disease; Gastroenterology; Portal hypertension; Cardiovascular disease; Digestive diseases; Hepatic disease
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1002/hep.24129

Severe portal hypertension is responsible for complications and death. Although measurement of the hepatic venous pressure gradient is the most accurate method for evaluating the presence and severity of portal hypertension, this technique is considered invasive and is not routinely performed in all centers. Several noninvasive techniques have been proposed to measure portal hypertension. Certain methods evaluate elements related to the pathogenesis of portal hypertension through the measurement of hyperkinetic syndrome, for example, or they investigate the development of hepatic fibrosis through the measurement of increased intrahepatic vascular resistance. Other methods evaluate the clinical consequences of portal hypertension, such as the presence of esophageal varices or the development of portosystemic shunts. Methods evaluating increased hepatic vascular resistance are fairly accurate and mainly involve the detection of hepatic fibrosis by serum markers and transient elastography. The radiological assessment of hyperkinetic syndrome probably has value but is still under investigation. The assessment of severe portal hypertension by the presence of varices may be performed with simple tools such as biological assays, computed tomography, and esophageal capsules. More sophisticated procedures seem promising but are still under development. Screening tools for large populations must be simple, whereas more complicated procedures could help in the follow‐up of already diagnosed patients. Although most of these noninvasive methods effectively identify severe portal hypertension, methods for diagnosing moderate portal hypertension need to be developed; this shows that further investigation is needed in this field. (HEPATOLOGY 2011;53:683‐694)