Portal hypertension and primary biliary cirrhosis: effect of long-term ursodeoxycholic acid treatment
Open accessAbstract
Background & aims Portal hypertension can complicate primary biliary cirrhosis, but studies evaluating the direct measurement of the portohepatic gradient (PHG) are rare. The aim of the study was to determine the prevalence and prognostic value of portal hypertension in patients treated with ursodeoxycholic acid.Methods A total of 132 patients from a local "PBC clinic" were enrolled in this cohort study. The PHG and biochemical values were measured at inclusion and every 2 years. Factors associated with survival were analyzed.Results Mean PHG at inclusion was 7.2 +/- 5.8 mm Hg. It was higher than normal (6 mm Hg) in 46 patients (34.9%) and higher than 12 mm Hg (variceal bleeding risk limit) in 26 patients (19.7%). There was a difference between the 3 subgroups in the probability of survival free of liver transplantation (P < .0003). After 2 years of treatment, a decreased or stable PHG (hazard ratio, 4.64; 95% confidence interval, 2.01-10.72) and normalization of aspartate aminotransferase (AST) level (hazard ratio, 2.89; 95% confidence interval, 1.03-8.05) were predictive of better survival on multivariate analysis. "Responders" (stable or improved PHG and normalized AST level at 2 years) have a 15-year survival similar to that of a control Quebec female population.Conclusions Significant portal hypertension is a common complication of primary biliary cirrhosis. Changes in the PHG and normalized AST level after 2 years of ursodeoxycholic acid treatment can be used to identify a subgroup of responders with survival comparable to that of a control population.
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Direct HVPG measurement in PBC correlates with the probability of death or liver transplantation.
“The direct measurement of the hepatic venous pressure gradient (HVPG) in PBC has been shown to correlate with the probability of death or liver transplant [99].”
From EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. (2017) · cites this paper as [99]
The Long-Term Follow-Up Data section reports that patients grouped by their initial pressure gradient differed significantly in survival free of liver transplantation. But the Measurement of the PHG section says the study measured the portohepatic gradient (PHG), using portal-vein and hepatic-vein pressures, not the hepatic venous pressure gradient (HVPG). The paper distinguishes those measures and notes that HVPG may underestimate PHG in PBC. Page numbers were not supplied. (LLM, conf=0.91)
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References 35 · Cited by 84
- Authors
- Huet, P., Vincent, C., Deslaurier, J., Coté, J., Matsutami, S., Boileau, R., & Huet–van Kerckvoorde, J.
- Affiliations
- Inserm (FR)
- Centre Hospitalier de l’Université de Montréal (CA)
- Corresponding author
- Huet, Pierre–Michel
- ORCID
- Vincent, Catherine
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2008-11
- Volume
- 135
- Issue
- 5
- Pages
- 1552-1560
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W1979310426
- Semantic Scholar
- f6ae4733e94ee8e718ddd486dae34e30b7161edb
- Cited by
- 84
- References
- 35
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 5 · 2020: 7 · 2019: 1 · 2018: 7 · 2017: 4 · 2015: 8 · 2014: 7 · 2013: 4 · 2012: 5
- FWCI
- 5.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Université de Montréal
- Topics
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Surgery › Pediatric Hepatobiliary Diseases and Treatments
- Keywords
- portal hypertension, primary biliary cirrhosis, ursodeoxycholic acid, variceal bleeding, survival, liver transplantation, aspartate aminotransferase, treatment response, prognostic factors
- MeSH terms
- Adult, Aged, Aspartate Aminotransferases, Cholagogues and Choleretics, Female, Follow-Up Studies, Humans, Hypertension, Portal, Liver Cirrhosis, Biliary, Male, Middle Aged, Prognosis, Quebec, Retrospective Studies, Time Factors, Ursodeoxycholic Acid, Prevalence, Survival Rate, Confidence Intervals, Odds Ratio, Treatment Outcome, Portal Pressure, Disease Progression
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