DOES THE MEASUREMENT OF PORTAL FLOW VELOCITY HAVE ANY VALUE IN THE IDENTIFICATION OF PATIENTS WITH CIRRHOSIS AT RISK OF DIGESTIVE BLEEDING

Upper gastrointestinal bleeding is a leading cause of death in patient s with liver cirrhosis. In most cases haemorrhage originates from oeso phageal varices or from congestive gastropathy, and the evaluation of the bleeding risk is based on oesophagogastroduodenoscopic data. The a im of this prospective study was to determine whether the measurement of portal flow velocity by Duplex-Doppler, compared with endoscopic da ta, can help in detecting patients with cirrhosis at risk of bleeding. One hundred and seventy-three patients underwent endoscopy to ascerta in the size of the varices and the severity of congestive gastropathy. For each patient maximal portal flow velocity measurements were obtai ned. No difference in portal flow velocity was observed between patien ts with or without oesophageal varices or congestive gastropathy. Duri ng a 2-year observation period, 27 patients (15.6%) had at least one e pisode of acute digestive bleeding. Stepwise multiple logistic regress ion analysis demonstrated a correlation between oesophageal varices an d congestive gastropathy endoscopic grading and the incidence of bleed ing; only the former was entered into the final regression equation (p <0.001). No relationship between the max portal flow velocity value an d incidence of bleeding was found. This study shows that portal flow v elocity is unrelated to the degree of the endoscopic abnormalities in patients with liver cirrhosis and that it has no value in the identifi cation of patients with cirrhosis at risk of upper gastrointestinal bl eeding.