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Differences in portal hemodynamics in cirrhosis and idiopathic portal hypertension
1First Department of Medicine, Chiba University School of Medicine, Japan.
Insights
Cirrhosis with splenomegaly shows distinct portal hemodynamics compared to idiopathic portal hypertension. These findings suggest cirrhosis with a large spleen does not originate from idiopathic portal hypertension.
Area of Science:
- Hepatology
- Gastroenterology
- Vascular Medicine
Background:
- Portal hypertension is a major complication of cirrhosis.
- Splenomegaly is common in cirrhotic patients and can indicate advanced disease.
- Idiopathic portal hypertension (IPH) is a distinct condition characterized by elevated portal pressure without cirrhosis.
Purpose of the Study:
- To compare portal hemodynamics in patients with cirrhosis and splenomegaly versus those without splenomegaly and patients with idiopathic portal hypertension.
- To elucidate the pathophysiological differences between these conditions.
Main Methods:
- A comparative hemodynamic study involving 79 cirrhotic patients (stratified by spleen size), 22 IPH patients, and 63 healthy controls.
- Measurement of portal and splenic venous flows, intrahepatic shunt index, portal vein pressure, and sinusoidal resistances.
Main Results:
- Portal and splenic venous flows increased progressively from cirrhosis without splenomegaly to cirrhosis with splenomegaly, and then to IPH.
- Intrahepatic shunting and portal vein pressure were significantly higher in cirrhosis with splenomegaly.
- Postsinusoidal resistance was elevated in both cirrhosis groups, while presinusoidal resistance was higher in IPH.
Conclusions:
- The distinct hemodynamic profiles differentiate cirrhosis with splenomegaly from IPH.
- These findings challenge the notion that cirrhosis with splenomegaly develops secondary to IPH.
Abstract:
A comparative study of portal hemodynamics was made in 79 cirrhotics (24 cirrhotics with a large spleen greater than or equal to 500 cm3 in volume, 55 cirrhotics with a spleen less than 500 cm3 in volume), 22 patients with idiopathic portal hypertension, and 63 healthy adults who served as the control for portal and splenic venous flows. Portal and splenic venous flows were significantly increased in the group order of the cirrhosis without splenomegaly group, the cirrhosis with splenomegaly group, and idiopathic portal hypertension group. Intrahepatic shunt index was significantly greater in the cirrhosis with splenomegaly group than in the cirrhosis without splenomegaly group, and it was negligible in the idiopathic portal hypertension group. Portal vein pressure was significantly elevated in the cirrhosis with splenomegaly group than in the cirrhosis without splenomegaly and idiopathic portal hypertension groups. Postsinusoidal resistances were significantly greater in the two groups of cirrhosis than in the idiopathic portal hypertension group, whereas presinusoidal resistance was significantly greater in the idiopathic portal hypertension group than in the two groups with cirrhosis. It is concluded that these differences are inconsistent with the view that cirrhosis with splenomegaly comes from idiopathic portal hypertension.