Patients with ascites have higher variceal pressure and wall tension than patients without ascites

OBJECTIVE: It has been suggested that ascites is a risk factor for variceal bleeding. Recently, it has been demonstrated that total paracentesis decre ases variceal pressure. However, no data are available showing the basal va riceal pressure in patients with and without ascites. METHODS: We studied 76 cirrhotic patients, 49 with and 27 without ascites. Variceal pressure was measured by direct puncture. Variceal size, variceal pressure gradient, and variceal wall tension were also obtained. RESULTS: No demographic differences were observed between the groups. Child score was higher (9.7 +/- 1.5 vs 7.8 +/- 2.1,p < 0.001) and serum albumin lower (2.6 +/- 0.6 vs 3.0 +/- 0.7 mg %, p < 0.02) in ascitic than in nonasc itic patients, respectively. Variceal pressure and variceal pressure gradie nt were significantly higher in patients with ascites than in those without ascites (25.0 +/- 6 vs 20.4 +/- 4.6 mm Hg, p < 0.001 and 18.75 +/- 4.7 vs 13.70 +/- 4.1 mm Hg, p < 0.0001, respectively). The variceal wall tension w as significantly higher in patients with ascites (71.0 +/- 25.1 mm Hg/mm) t han in those without ascites (55.1 +/- 22.1 mm Hg/mm, p < 0.03). No relatio nship was observed between variceal pressure gradient and liver function. A scites patients included in Child-Pugh grade A+B presented a similar varice al pressure to Child C patients (18.5 +/- 4.2 vs 19.3 +/- 5.7 mm Hg, respec tively, p = ns). In addition, no relationship was observed between variceal pressure gradient and etiology of cirrhosis. CONCLUSION: Our results demonstrate that patients with ascites have signifi cantly higher variceal pressure and wall tension than patients without asci tes. These results suggest that patients with ascites may be at risk for va riceal bleeding. (C) 2000 by Am. Coll. of Gastroenterology).