Significance of liver/spleen stiffness in patients with portal hypertension-related gastrointestinal lesions

Abstract

Portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE) as well as esophagogastric varices (EV) are crucial complications, which may provoke gastrointestinal bleeding, in patients with portal hypertension. Recently, the liver stiffness measured using ultrasound was shown to be associated with the extent of portal hypertension. Moreover, we previously reported that the spleen stiffness also showed association with hepatic venous pressure gradient (HVPG), which may reflect the risk for EV bleeding. Thus, in the present study, the significance of liver/spleen stiffness on possible risk for bleeding from hypertension-related gastrointestinal lesions (PHRGLs), including PHG and GAVE as well as EV, was investigated. A total of 92 patients with chronic liver diseases were enrolled, and the relation between PHRGLs and clinical factors such as hepatocellular carcinoma, liver function and liver/spleen stiffness were evaluated. EV, PHG, and GAVE were seen in 41.3%, 43.5%, and 9.8% of patients, respectively. Liver stiffness (mean±SD) was greater in patients with PHRGLs (2.114±0.060) than in those without PHRGLs (1.802±0.046) (p＜0.005). Spleen stiffness was also greater in the former patients (2.621±0.102) than in the latter patients (2.263±0.041) (p＜0.05). Multivariate analysis identified the spleen stiffness, peripheral platelet counts and serum albumin levels as significant factors responsible for development of PHRGLs. In conclusion, although both liver stiffness and spleen stiffness showed association with PHRGLs development, the spleen stiffness was the most useful factor predicting the occurrence of PHRGLs.