The study of hepatic hemodynamics: research activity or clinical tool?

Portal hypertension is a progressive complication of cirrhosis. Therefore, the management of a patient with cirrhosis and gastrointestinal bleeding depends largely on the stage of the portal hypertension. The patient may be in the pre-variceal stage or present with acute variceal bleeding, in which case the objectives are to control the current hemorrhage and prevent recurrence. In clinical practice, the severity of portal hypertension can be estimated, reliably and safely, by transjugular measurement of the hepatic venous pressure gradient (HVPG). After a brief review of the pathophysiology of portal hypertension in cirrhosis, the authors describe the technique used to measure transjugular HVPG, its prognostic value in patients with cirrhosis, the pros and cons of including this procedure in routine work-ups of these patients, and its potential roles in monitoring responses to treatment and in the preoperative assessment of cirrhotic patients undergoing hepatic resection.