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Invasive Hemodynamic Characterization of the Portal-hypertensive Syndrome in Cirrhotic Rats
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Ultrasonic evaluation of portosystemic collateral circulation in portal hypertension

S G Sheth1, D N Amarapurkar, K B Chopra

  • 1TN Medical College, Bombay.

The Journal of the Association of Physicians of India
|August 1, 1996
PubMed

Insights

Portosystemic collateral circulation decompresses portal hypertension, preventing or reducing esophageal varices. This circulation is more common in non-cirrhotic patients and those treated with sclerotherapy, and does not cause ascites.

Area of Science:

  • Gastroenterology
  • Hepatology
  • Vascular Medicine

Background:

  • Portal hypertension is a serious condition characterized by elevated pressure in the portal vein system.
  • Portosystemic collateral circulation develops as a compensatory mechanism to decompress the portal system.
  • Understanding the role of collateral circulation is crucial for managing portal hypertension and its complications.

Purpose of the Study:

  • To evaluate portosystemic collateral circulation in patients with portal hypertension.
  • To assess the relationship between collateral circulation and etiological groups, esophageal varices, sclerotherapy, and ascites.
  • To elucidate the decompressive role of portosystemic circulation in portal hypertension.

Main Methods:

  • A prospective study involving 101 patients diagnosed with portal hypertension.
  • Patients were categorized into four etiological groups: Alcoholic Cirrhosis (ALD), Non-alcoholic Cirrhosis (NALD), Non-cirrhotic Portal Fibrosis (NCPF), and Extrahepatic Portal Vein Obstruction (EHPVO).
  • Esophageal varices were endoscopically graded, and other portosystemic collaterals were evaluated using ultrasonography.

Main Results:

  • Portosystemic collaterals were observed in 26% of patients, being more frequent in non-cirrhotic groups (NCPF and EHPVO) than in cirrhotic groups (ALD and NALD).
  • Collateral shunts were more prevalent in patients without esophageal varices and those who had undergone esophageal sclerotherapy.
  • Gallbladder varices were the only ectopic varices identified, with an incidence of 3.96%.

Conclusions:

  • Portosystemic collateral circulation plays a significant decompressive role in portal hypertension.
  • This circulation appears to prevent the formation or progression of esophageal varices.
  • Collateral circulation was not found to contribute to the development of ascites and was more common in non-cirrhotic patients and those treated with sclerotherapy.

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