Variceal pressure is a strong predictor of variceal haemorrhage in patients with cirrhosis as well as in patients with non-cirrhotic portal hypertension

Background-Variceal pressure is a strong predictor for a first variceal ble ed in patients with cirrhosis. Aims-To evaluate whether variceal pressure is also a determinant of the ris k of a first variceal bleed in patients with noncirrhotic portal hypertensi on. Methods-Variceal pressure was measured non-invasively in 25 patients with n on-cirrhotic portal hypertension and large varices while receiving a stable therapeutic regimen. Factors predictive of bleeding were compared with tho se observed in 87 cirrhotics. Results-The one year incidence of variceal bleeding was 32% (n = 28) for th e cirrhotic and 20% (n = 5) for the noncirrhotic patients. There was no dif ference in factors predicting the risk of bleeding between the groups, exce pt for variceal pressure. For the same level of variceal pressure, the risk of variceal bleeding was lower in patients with non-cirrhotic portal hyper tension. Multiple logistic regression analysis revealed the following varia bles as having a significant predictive power: variceal pressure (p = 0.000 1), red spots (p = 0.004), and the time interval between the first observat ion of the varices and the moment of variceal pressure measurement (p = 0.0 046). For the non-cirrhotics the risk of bleeding increased with higher Chi ld-Pugh score (p = 0.0024); this was not the case for the cirrhotic patient s (p = 0.9521). Conclusion-Variceal pressure is a major predictor of variceal bleeding in p atients with cirrhosis as well as in patients with non-cirrhotic portal hyp ertension. The risk of bleeding in non-cirrhotics is less than in cirrhotic s for the same level of variceal pressure. In patients with noncirrhotic po rtal hypertension the risk of variceal bleeding increases more with advanci ng disease.