Saad Elias, Barhoum Masad, Assy Nimer
Cirrhosis represents the final stage for wide variety of chronic liver diseases, regardless of its etiology, and the development of portal hypertension is responsible for the pathogenesis of most frequent and fatal complications of cirrhosis. It is of most importance to evaluate patients newly diagnosed with cirrhosis for the presence of clinically significant portal hypertension and associated complications, which could expose the patient to fatal conditions such as variceal bleeding. The most accurate method for evaluating the presence and severity of portal hypertension is the measurement of the hepatic venous pressure gradient, which in one hand provides us valuable prognostic information but on the other hand, it represents a problematic technique, because it is invasive, costly and not available in all centers. Several alternative noninvasive techniques have been proposed to assess portal hypertension, including serum biomarkers and imaging techniques. Various serum molecules have been investigated for their ability to predict the presence of portal hypertension, some of which have showed to either correlate with the hepatic venous pressure gradient or predict clinically significant portal hypertension. This chapter will focus on the potential role of multiple serum markers of portal hypertension that could be clinically applicate to predict the presence of clinically significant portal hypertension, to stratify patients with respect to the severity of portal hypertension, to predict lethal complications such as variceal bleeding, and to monitor disease progression or treatment response without exposing patients to the risks of repeated invasive assessment.