Re: Portal Hypertension and PBC: Effect of Long-Term Ursodeoxycholic Acid Treatm

[Guest guest]

>

> This article seems to say that, by calculating the effect on

> the " portohepatic gradient " of Urso, you can predict transplant-free

> survival in PBC patients. Does anyone know how to calculate

> the " portohepatic gradient " ?

Nina,

The portohepatic gradient (HVPG) is the difference in pressure between

the portal vein, which collects the blood from the stomach and

intestines and carries it to the liver, and the hepatic vein, which

carries the blood out of the liver into the vena cava and thence back

to the heart. Direct measurements of the HVPG can be obtained by

ultrasound-guided fine needle puncture of a hepatic vein and the

portal vein. But usually the pressure is measured by pushing a probe

against a vein in the portal system (such as in the esophagus) and

measuring the deflection, thus inferring the pressure. Much as

glaucoma in the eye is measured by a probe pushing against the numbed

eyeball, not by sticking a pressure sensor into the eyeball. Pressures

above normal (6mmHg) are indicative of portal hypertension and those

above 10 or 12 mmHg indicative of high risk of esophagal varicies and

bleeds.

I think the study says that in those with PBC, if the HVPG remains or

returns to normal when treated with urso (and they have normal AST)

their life expectancy is normal. Those with portal hypertension

(usually associated with cirrhosis) which doesn't respond to urso

don't do so well. I think this implies that starting urso before the

later stages is important in PBC and probably in PSC too. The benefit

to a cirrhotic liver is not too great.

Tim R

[Guest guest]

Great explanation - thanks!

Arne

57 - UC 1977 - PSC 2000

Alive and well in Minnesota

________________________________

From: [mailto: ] On Behalf Of Tim Romlein

....Direct measurements of the HVPG can be obtained by

ultrasound-guided fine needle puncture of a hepatic vein and the

portal vein. But usually the pressure is measured by pushing a probe

against a vein in the portal system (such as in the esophagus) and

measuring the deflection, thus inferring the pressure. Much as

glaucoma in the eye is measured by a probe pushing against the numbed

eyeball, not by sticking a pressure sensor into the eyeball...