Comparison between Esophageal Variceal Pressure and Portal Pressure in Hbsag-Positive Cirrhotics: The Effects of Vasopressin

Abstract

Thirteen patients with HBsAg-positive cirrhosis were studied to investigate the relationship between esophageal variceal pressure and portal pressure, and the role of variceal pressure measurements in the management of portal hypertension. The intravariceal pressure, esophageal variceal pressure gradient, wedged hepatic venous pressure and hepatic venous pressure gradient were 21.4±2.8 mmHg, 16.2±2.2 mmHg, 23.1±5.5 mmHg and 14.7±3.9 mmHg, respectively. Linear regression analysis showed poor correlation between wedged hepatic venous pressure and intravariceal pressure or between hepatic venous pressure gradient and esophageal variceal pressure gradient. In nine patients receiving intravenous infusion of vasopressin (1 IU), both esophageal variceal pressure gradient (15.7±2.0 vs. 11.2±2.6 mmHg, p＜0.01) and hepatic venous pressure gradient (14.7±3.5 vs. 11.0±2.9 mmHg, p＜0.0l) were reduced. The reduction of esophageal variceal pressure gradient after vasopressin infusion (4.4±1.4 mmHg, 29.0±11.4%) tended to correlate with that of hepatic venous pressure gradient (3.4±0.9 mmHg, 24.2±3.8%) (r=0.64, p=0.06). These results indicate that esophageal variceal pressure measurements cannot be used as estimations of portal pressure in HBsAg-positive cirrhotics. However, the measurement of esophageal variceal pressure may be valuable in assessing potential drug effects in the management of portal hypertension.