Should we routinely measure portal pressure in patients with cirrhosis, using hepatic venous pressure gradient (HVPG) as guidance for prophylaxis and treatment of bleeding and re-bleeding? Yes!

Use of portal pressure studies in the management of variceal haemorrhage

“…This clearly indicates the need for ongoing research in this area. The number of patients required to carry out a randomized control trial comparing beta blocker therapy and HVPG monitoring with unselected beta blocker treatment are large (n = 600) and have financial and resource implications for a study group to take on [73] . Raines et al [74] proposed a model to evaluate the cost and efficacy of routine HVPG measurement to guide secondary prophylaxis of recurrent variceal bleedingwhilst combination therapy (beta blockers and band ligation) with two HVPG measurements was expensive, it became cost-effective at 1 year compared with standard prophylaxis with combination pharmacotherapy.…”

Propranolol treatment of portal hypertension in cirrhosis patients is better the higher the untreated pressure: a single-centre prospective experience

“…This implies that many patients are at risk of side effects to the b-blockade without benefitting from the reduction in risk for variceal bleeding [3,4]. It is, therefore, often advocated that the HVPG should be measured as guidance for the effect and maintenance of treatment [5].…”

Schistosomiasis and hepatopulmonary syndrome: the role of concomitant liver cirrhosis

“…Hence, because the portal pressure was not measured, this point remains unclarified, and therefore constitutes one of the limitations of this study. However, the measurement of the hepatic venous pressure gradient, a method used to obtain the portal pressure level in patients with cirrhosis, does not properly assess the pressure in the venous portal system in patients with HSS because these patients present pre-sinusoidal portal hypertension (Coutinho 1968, Merkel & Montagnese 2011). …”