Portal hypertension: a permissive factor only in the development of ascites and variceal bleeding

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Abstract
It is controversial whether the occurrence of ascites and gastrointestinal bleeding in cirrhosis is related to the severity of portal hypertension. Portal pressure was examined in 124 unselected patients with portal hypertension due to chronic liver disease to evaluate this issue. Portal pressure was less in patients without complications of chronic liver disease (11.7 .+-. 3.0 mmHg, n = 16) as compared to patients who had bled from varices or erosive gastritis (16.6 .+-. 3.4 mmHg, p < 0.001, n = 49), who had ascites (16.2 .+-. 3.0 mmHg, p < 0.001, n = 78) or both (16.5 .+-. 3.0 mmHg, p < 0.001, n = 19). Portal pressure was similar in patients bleeding from varices and erosive gastritis (16.7 .+-. 3.4 mmHg, n = 43; vs 16.2 .+-. 4.0 mmHg, n = 6, respectively) and in patients with refractory and nonrefractory ascites (16.2 .+-. 3.5, n = 21; vs 16.2 .+-. 3.5 mmHg, n = 57). The lowest portal pressure recorded in a patient with variceal bleeding was 9.0 mmHg. The lowest portal pressure recorded in a patient with ascites was 8.0 mmHg. Esophageal varices (graded 0-4 at endoscopy) were larger in patients with a history of bleeding from esophageal varices as compared to patients without such a history (3.2 .+-. 0.7 vs 2.0 .+-. 0.9, p < 0.001). Serum albumin concentration was greater in patients without ascites as compared to patients with ascites (33 .+-. 5 vs 26 .+-. 5 g/l p < 0.001) but was similar in patients with refractory and nonrefractory ascites (25 .+-. 7 vs 26 .+-. 5 g/l, respectively). These data suggest that portal hypertension is a permissive factor only in the development of ascites and gastrointestinal bleeding in patients with chronic liver disease.