β-Blockers Improve Presinusoidal Portal Hypertension

Abstract

Background: Presinusoidal portal hypertension is a clinically important cause of gastric and gastroesophageal varices. Whereas β-blockers have an established prophylactic role against bleeding from esophageal and gastric varices in portal hypertension due to cirrhosis, the effect on presinusoidal portal hypertension is unknown.

Aims: To evaluate the hemodynamic effect of β-blockers in non-cirrhotic patients with presinusoidal portal hypertension.

Methods: We measured the blood pressure gradient from spleen pulp to free hepatic vein in 12 patients with presinusoidal portal hypertension by combined hepatic vein catheterization and spleen pulp puncture while on and off β-blocker treatment (random sequence).

Results: The β-blockers reduced the gradient from a mean off-treatment value of 32 mm Hg to a on-treatment value of 26 mm Hg (P < 0.05) with a reduction of at least 20% in five patients (42%).

Conclusions: β-blocker treatment caused a clinically significant reduction in the pressure gradient from spleen pulp to the free hepatic vein. This finding supports the recommendation for prophylactic β-blockage in patients with presinusoidal portal hypertension.

Keywords: Gastroesophageal varices; Non-cirrhotic portal hypertension; Portal vein thrombosis; Propranolol; Splenic vein thrombosis.

Fig. 1

Individual pairs of blood pressure gradients from spleen pulp to free position in hepatic vein in patients with presinusoidal portal hypertension. Each subject was investigated off (left) and on (right) treatment. Mean values for the groups are represented by horizontal lines