β-Blockers Improve Presinusoidal Portal Hypertension

BackgroundPresinusoidal portal hypertension is a clinically important cause of gastric and gastroesophageal varices. Whereas -blockers have an established prophylactic role against bleeding from esophageal and gastric varices in portal hypertension due to cirrhosis, the effect on presinusoidal portal hypertension is unknown.AimsTo evaluate the hemodynamic effect of -blockers in non-cirrhotic patients with presinusoidal portal hypertension.MethodsWe measured the blood pressure gradient from spleen pulp to free hepatic vein in 12 patients with presinusoidal portal hypertension by combined hepatic vein catheterization and spleen pulp puncture while on and off -blocker treatment (random sequence).ResultsThe -blockers reduced the gradient from a mean off-treatmentvalue of 32mmHg to a on-treatment value of26mmHg (P<0.05) with a reduction of at least 20% in five patients (42%).Conclusions-blocker treatment caused a clinically significant reduction in the pressure gradient from spleen pulp to the free hepatic vein. This finding supports the recommendation for prophylactic -blockage in patients with presinusoidal portal hypertension.