Abstract: Objective To investigate the possible causes of low liver stiffness measurement in patients with esophageal and gastric varices bleeding.Methods The clinical data of 29 patients with liver stiffness measurement less than 12kPa and 37 patients with liver stiffness measurement greater than 17.5kpa who visited Beijing Ditan Hospital due to esophageal and gastric varices rupture bleeding from January 2017 to October 2019 were retrospectively analyzed. The differences of liver function, portal hemodynamic indicators, etiology and complications between these two groups of patients were compared. Results Compared with the patients in the group of liver stiffness measurement ≤ 12kPa, patients in the group of liver stiffness measurement≥ 17.5kPa had significantly lower levels of albumin (Alb)(Z=-3.05, P=0.002), cholinesterase (CHE)(Z=-3.81, P=0.000), Prothrombin activity (PTA)(Z=-2.34, P=0.019), platelet (PLT) count(Z=-2.29, P=0.022), and significantly higher Child-Puch (CHILD) scores (Z=-2.41, P=0.016), levels of aspartate aminotransferase(AST)(Z=-2.33, P=0.020)and aspartate aminotransferase(Cr)(Z=-1.97, P=0.048), prolongation of prothrombin time(PT)(Z=-2.88 ,P=0.004)and International Normalized Ratio(INR)(Z=-2.15, P=0.031). The etiologies of patients in the LSM≤ 12kPa group was mainly idiopathic portal hypertension (34.4%) and hepatitis B viral infection (44.8%), while in the LSM≥ 17.5kPa group were mainly hepatitis B virus infection (40.5%) and alcoholic (32.4%). The difference of etiological composition ratio was statistically significant (χ²=11.3, P=0.023). The difference in developing complications and the rate of ascites between these two groups had no statistical significance (χ²=0.695, P=0.405, χ² = 2.363, P=0.124).Conclusion Esophageal and gastric varices bleeding is not always caused by cirrhosis. It may also be due to idiopathic portal hypertension. The degree of portal hypertension and the risk of bleeding cannot be predicted by liver stiffness measurement alone.

Key words: Liver stiffness measurement, Liver cirrhosis, Esophageal and gastric varices rupture bleeding, Etiology, Portal hypertension