Non-invasive variceal pressure measurements: validation and clinical implications

Recently, it has become clear that the best way to reduce the mortality related to a variceal bleeding is to prevent it. Since however not all patients will bled, a way to predict a variceal hemorrhage is therefore urgently needed. The current endoscopic scores for the prediction of variceal bleeding are based on rather subjective markers. The present experimental work added the measured variceal pressure to this scoring systems, but a large number of patients should prospectively be evaluated to allow development of a model based on numerical data. Medical treatment of variceal bleeding, both to prevent and to stop the bleeding, became the treatment of choice for the majority of our cirrhotic patients. Our present investigations demonstrated that the non-invasive measurement of variceal pressure with the endoscopic gauge represent a reliable technique to assess the effect of drug treatment for portal hypertension both in acute and chronic conditions. Non invasive variceal pressure measurement may play therefore a crucial role in the future care of patients with chronic liver disease and portal hypertension. Developments with regard to primary or secondary prevention of bleeding will depend on further insight to be gained in the pathogenesis of the development of varices in a variety of experimental models and in patients. The mechanisms of action and the effect on portal hypertension of a series of drugs has further to be investigated. Experience gained till now in the cardiovascular domain will greatly speed up this process but fundamental research on neurohumeral processes involved will be further essential.