Beta-blocker Stratification using quantitative MRI techniques to assess portal pressure and Response to Treatment in patients with portal hypertension (B-SMaRT)

1st January 2017 - ongoing

Status: In Recruitment

Specialism: Imaging, MR Imaging, Liver.

Team: Dr Rob ScottProfessor Guruprasad AithalProfessor Penny GowlandDr Neil GuhaDr Susan FrancisEleanor CoxChris BradleyShellie Radford.

Aim

To test if MRI can detect meaningful changes in portal pressure in the liver to assess whether treatment with beta-blockers has worked.

Liver Disease

Most people with liver disease do not have symptoms. Over time they develop ‘cirrhosis’ - severe liver scarring. In the UK deaths due to cirrhosis have doubled over the last decade, because of increasing rates of alcohol consumption and obesity, while heart, kidney, lung diseases, strokes and cancer fatalities have fallen.

Portal pressure

Cirrhosis causes increased pressure within the liver and changes in the circulation leading to the development of varicose veins in the gullet and stomach called ‘varices’. Varices bleed easily, leading to emergency situations that can be life threatening. However, if the increased pressure within the liver (portal pressure) is detected early, then treatment can prevent variceal bleeding. The only test we have to predict prognosis and treatment success in someone with cirrhosis is by measuring the portal pressure.

Measuring portal pressure

Currently the only existing test to measure portal pressure is to pass a pressure sensor through a vein in the neck, down into the liver. This is called the hepatic venous pressure gradient (HVPG) measurement. The HVPG measurement is disliked by patients because it is an invasive procedure. It is also expensive and not widely available in the NHS. Hence, patients with cirrhosis need to have regular camera tests (endoscopies) to look for varices.

How can you treat varices?

Two options;

  1. With tablets to lower the pressure (beta-blockers)
  2. Endoscopy treatment (banding)

Both have advantages and disadvantages;

  • Beta-blockers only lower the portal pressure in about half of those that take them, with some evidence they may also have a protective effect against infections from the bowel by increasing the speed of bowel motion
  • Treating the varices with endoscopy requires several endoscopies and can lead to life-threatening bleeding.

Most patients are therefore given beta-blockers and monitored closely to see if they work.

Why does it matter?

Beta-blockers can cause side effects (e.g. fainting) that are unpleasant enough to make up to one third of patients stop taking them. Beta-blockers only reduce the portal pressure in half of patients. The remaining patients are exposed to potential side effects and possible harm in those with the most advanced liver disease. These patients may still have a life-threatening bleed as the varices have not been adequately treated. There is a desperate need to discover whether the portal pressure changes with treatment (such as with beta-blockers) without invasive tests across the NHS.

Proposed study

Researchers in Nottingham have shown MRI can be used as an accurate marker of portal pressure with just one scan. To be useful to patients, doctors and researchers, this study will investigate whether MRI can detect meaningful changes in portal pressure after treatment with beta-blockers. This study is designed with patient and public involvement (PPI) integrated throughout. A focus group shaped the study design and committed to collaborate in developing patient materials, recruitment, retention and dissemination.

People
Photo Name Bio
dr-rob-scott Dr Rob Scott
guruprasad-aithal Professor Guruprasad Aithal Professor Aithal has been a Consultant Hepatobiliary Physician at Nottingham University Hospitals NHS trust since 2001. He is the Head of the NIHR Nottingham Digestive Diseases Biomedical Research Centre, and the Head of Division for the Nottingham…
professor-penny-gowland Professor Penny Gowland Developing quantitative MRI for biomedical applications. I am particularly interested in exploiting the capabilities of functional and anatomical ultra-high field MRI in neuroscience, in using the increased contrast to noise ratio available at ultrahigh…
neil-guha Dr Neil Guha Dr Neil Guha is a Clinical Associate Professor in Hepatology at the University of Nottingham. He trained at Guy's and St. Thomas's hospitals and began his postgraduate career in hepatology at St. Mary's Hospital, London. His doctoral thesis, awarded by…
Dr Susan Francis My research has centred on developing Magnetic Resonance Imaging (MRI) methods for biomedical applications, over the last ~ 15 years in this field. This has included the application and development of functional magnetic resonance imaging (fMRI)…
Eleanor Cox
Chris Bradley
Shellie Radford
Publications
Title
Grants
Title Amount