PORTAL SYSTEMIC SHUNTING IN PATIENTS WITH ALCOHOLIC LIVER-DISEASE - RELATIONSHIPS WITH PORTAL PRESSURE, HISTOLOGICAL LESIONS AND LIVER-FUNCTION

Objective: The aim of this prospective study was to determine whether portal-systemic shunting in patients with alcoholic liver disease was related to histological staging, portal pressure and liver function. Patients: Thirty-seven patients with alcoholic liver disease diagnosed by biopsy were entered into the study and divided into three groups. Group 1 was composed of 13 patients with no or slight central fibrosis. Group 2 consisted of 10 patients with moderate to extensive fibrosis without complete nodularity (precirrhotic stage). Group 3 included 14 patients with fully developed cirrhosis. Interventions: A Tc-99m-pertechnetate per rectal portal scintigraphy was used to calculate a 'shunt index', which provides a quantitative estimation of total shunting. Portal haemodynamics were studied by hepatic vein catheterization. Liver function was assessed by the aminopyrine breath test (ABT) and the Child-Pugh score. Results: The shunt index values ranged from 0.10 to 5.0 in group 1 (median 0.20), from 2.0 to 95 in group 2 (median 14.2) and from 29 to 100 in group 3 (median 68). The shunt index was correlated significantly with wedged hepatic pressure (P < 0.001) and hepatic venous gradient (P < 0.001) but in individual case, did not provide an accurate measure of portal pressure. A poor correlation (P < 0.05) was found between shunt index and ABT but there was no correlation between the shunt index and Child-Pugh score. Conclusions: Serial measurements of shunt index give information on the progression of fibrotic process and are a safe, non-invasive method for monitoring the development of portal hypertension. Liver function seems to be poorly related to total shunting.