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Noninvasive evaluation of portal hypertension: emerging tools and techniques.

Snowdon VK, Guha N, Fallowfield JA - Int J Hepatol (2012)

Bottom Line: However, evaluating the development and progression of portal hypertension represents a challenge for clinicians.The pathogenesis of portal hypertension is increasingly understood and emerging knowledge of the vascular processes that underpin portal hypertension has paved the way for exploring novel biomarkers of vascular injury, angiogenesis, and endothelial dysfunction.In this paper we focus on the pathogenesis of portal hypertension and potential non-invasive biomarkers with particular emphasis on serum analytes.

View Article: PubMed Central - PubMed

Affiliation: MRC/Centre for Inflammation Research, QMRI, University of Edinburgh, Edinburgh EH16 4TJ, UK.

ABSTRACT
Portal hypertension is the main cause of complications in patients with cirrhosis. However, evaluating the development and progression of portal hypertension represents a challenge for clinicians. There has been considerable focus on the potential role of noninvasive markers of portal hypertension that could be used to stratify patients with respect to the stage of portal hypertension and to monitor disease progression or treatment response in a longitudinal manner without having to undertake repeated invasive assessment. The pathogenesis of portal hypertension is increasingly understood and emerging knowledge of the vascular processes that underpin portal hypertension has paved the way for exploring novel biomarkers of vascular injury, angiogenesis, and endothelial dysfunction. In this paper we focus on the pathogenesis of portal hypertension and potential non-invasive biomarkers with particular emphasis on serum analytes.

No MeSH data available.


Related in: MedlinePlus

Clinical importance of portal hypertension.
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fig1: Clinical importance of portal hypertension.

Mentions: Portal hypertension (PHT) is the most important consequence of cirrhosis and its presence is a hard endpoint for clinically relevant outcomes in terms of varices, ascites, hepatorenal syndrome, and encephalopathy [1]. The current gold standard for measuring PHT and its severity is measurement of the hepatic venous pressure gradient (HVPG). The prognostic value of PHT measurement at different stages in the natural history of chronic liver disease is well established, with cut-off values for the development of complications (HVPG > 10 mmHg) and variceal rupture (HVPG > 12 mmHg) [2, 3]. A reduction in HVPG (e.g., after drug therapy) below 12 mm Hg or by >20% from baseline is associated with a significant reduction in complications and death. In addition, HVPG is also emerging as a reliable endpoint to assess disease progression and therapeutic response in chronic liver disease. The importance of PHT is summarised in Figure 1 showing how changes in the HVPG affect clinical outcomes. Although HVPG measurement is safe and relatively simple to perform, it is invasive, costly, and only performed in specialist centres [4]. A recommendation from the Baverno V Consensus Workshop on Methodology of Diagnosis and Therapy in PHT was to identify noninvasive tools for detecting PHT [5], which could have clinical utility for monitoring changes in PHT over time.


Noninvasive evaluation of portal hypertension: emerging tools and techniques.

Snowdon VK, Guha N, Fallowfield JA - Int J Hepatol (2012)

Clinical importance of portal hypertension.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3376538&req=5

fig1: Clinical importance of portal hypertension.
Mentions: Portal hypertension (PHT) is the most important consequence of cirrhosis and its presence is a hard endpoint for clinically relevant outcomes in terms of varices, ascites, hepatorenal syndrome, and encephalopathy [1]. The current gold standard for measuring PHT and its severity is measurement of the hepatic venous pressure gradient (HVPG). The prognostic value of PHT measurement at different stages in the natural history of chronic liver disease is well established, with cut-off values for the development of complications (HVPG > 10 mmHg) and variceal rupture (HVPG > 12 mmHg) [2, 3]. A reduction in HVPG (e.g., after drug therapy) below 12 mm Hg or by >20% from baseline is associated with a significant reduction in complications and death. In addition, HVPG is also emerging as a reliable endpoint to assess disease progression and therapeutic response in chronic liver disease. The importance of PHT is summarised in Figure 1 showing how changes in the HVPG affect clinical outcomes. Although HVPG measurement is safe and relatively simple to perform, it is invasive, costly, and only performed in specialist centres [4]. A recommendation from the Baverno V Consensus Workshop on Methodology of Diagnosis and Therapy in PHT was to identify noninvasive tools for detecting PHT [5], which could have clinical utility for monitoring changes in PHT over time.

Bottom Line: However, evaluating the development and progression of portal hypertension represents a challenge for clinicians.The pathogenesis of portal hypertension is increasingly understood and emerging knowledge of the vascular processes that underpin portal hypertension has paved the way for exploring novel biomarkers of vascular injury, angiogenesis, and endothelial dysfunction.In this paper we focus on the pathogenesis of portal hypertension and potential non-invasive biomarkers with particular emphasis on serum analytes.

View Article: PubMed Central - PubMed

Affiliation: MRC/Centre for Inflammation Research, QMRI, University of Edinburgh, Edinburgh EH16 4TJ, UK.

ABSTRACT
Portal hypertension is the main cause of complications in patients with cirrhosis. However, evaluating the development and progression of portal hypertension represents a challenge for clinicians. There has been considerable focus on the potential role of noninvasive markers of portal hypertension that could be used to stratify patients with respect to the stage of portal hypertension and to monitor disease progression or treatment response in a longitudinal manner without having to undertake repeated invasive assessment. The pathogenesis of portal hypertension is increasingly understood and emerging knowledge of the vascular processes that underpin portal hypertension has paved the way for exploring novel biomarkers of vascular injury, angiogenesis, and endothelial dysfunction. In this paper we focus on the pathogenesis of portal hypertension and potential non-invasive biomarkers with particular emphasis on serum analytes.

No MeSH data available.


Related in: MedlinePlus