The portal venous-esophageal luminal pressure gradient may be more important than the absolute portal venous pressure in explaining hemorrhages caused by esophageal varices. A continuous recording of portal venous pressure and the esophageal luminal pressure enabled the authors to study the gradient between these pressures in 12 cirrhotic patients with varices of different size and under different circumstances, in particular inspiration, expiration, coughing and a Valsalva maneuver.
A significant increase of portal venous pressure occurred during inspiration (+15%), coughing (+77%) and Valsalva maneuver (+157%). The value of portal venous-esophageal luminal pressure gradient increased during inspiration (+38%), coughing (+go%) and Valsalva maneuver (+69%) while it decreased during expiration (-14%).
The most threatening and lethal event for cirrhotic patients is acute bleeding due to esophageal varices. Different risk factors for such acute bleeding have been identified portal hypertension (1, 2); size of the varices (3), and thinness of variceal walls (4). To assess the risk of acute bleeding, the concept of the porto-esophageal pressure gradient, recently defined (4), may be more useful than the hepatic venous pressure gradient. Burcharth and Bertheussen (5) have showed that the absolute level of portal hypertension varies greatly under different physiological conditions, such as coughing and Valsalva maneuver. In addition, recent observations have suggested that coughing may precipitate variceal hemorrhage (Westaby, D. et al., Burette, A. et al., and Reding, P. et al., unpublished observations).
Therefore, the authors decided to study the portal venous-esophageal luminal pressure gradient (PEPG) in cirrhotic patients with esophageal varices of different size and under different conditions.
PATIENTS AND METHODS
Twelve consecutively admitted patients with cirrhosis of the liver, each having given an informed consent, were included in the study. All had severe portal hypertension and esophageal varices, variceal bleeding and/or ascites. The cirrhosis was