Article Text

PDF
The extent of the collateral circulation influences the postprandial increase in portal pressure in patients with cirrhosis
  1. Agustín Albillos1,
  2. Rafael Bañares2,
  3. Mónica González1,
  4. Maria-Vega Catalina2,
  5. Oscar Pastor3,
  6. Rosario Gonzalez1,
  7. Cristina Ripoll2,
  8. Jaime Bosch4
  1. 1Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
  2. 2Servicio de Gastroenterología, Hospital Universitario General Gregorio Marañón, Universidad Complutense, Madrid, Spain
  3. 3Servicio de Bioquímica Clínica, Hospital Universitario Ramón y Cajal, Madrid, Spain
  4. 4Servicio de Hepatología, Hospital Clinic IDIBAPS, Universidad de Barcelona, Barcelona, Spain
  1. Correspondence to:
    Professor A Albillos
    Departamento de Medicina, Facultad de Medicina-Campus Universitario, Universidad de Alcalá, Carretera Madrid-Barcelona km 33.600, 28871 Alcalá de Henares, Madrid, Spain;aalbillosm{at}meditex.es

Abstract

Background: In cirrhosis, repeated flares of portal pressure and collateral blood flow provoked by postprandial hyperaemia may contribute to variceal dilation and rupture.

Aim: To examine the effect of the extent of the collateral circulation on the postprandial increase in portal pressure observed in cirrhosis.

Patients and methods: The hepatic venous pressure gradient (HVPG), hepatic blood flow and azygos blood flow were measured in 64 patients with cirrhosis before and after a standard liquid meal.

Results: Peak increases in HVPG (median+14.9%), hepatic blood flow (median+25.4%), and azygos blood flow (median+32.2%) occurred at 30 min after the meal. Compared with patients with marked postprandial increase in HVPG (above the median, n = 32), those showing mild (<15%, n = 32) increase in HVPG had a higher baseline azygos flow (p<0.01) and underwent a greater postprandial increase in azygos flow (p<0.02). Hepatic blood flow increased similarly in both groups. Postprandial increases in HVPG were inversely correlated (p<0.001) with both baseline azygos flow (r = −0.69) and its postprandial increase (r = −0.72). Food intake increased nitric oxide products in the azygos (p<0.01), but not in the hepatic vein. Large varices (p<0.01) and previous variceal bleeding (p<0.001) were more frequent in patients with mild increase in HVPG.

Conclusions: Postprandial hyperaemia simultaneously increases HVPG and collateral flow. The extent of the collateral circulation determines the HVPG response to food intake. Patients with extensive collateralisation show less pronounced postprandial increases in HVPG, but associated with marked flares in collateral flow. Collateral vessels preserve their ability to dilate in response to increased blood flow.

  • AzBF, azygos blood flow
  • HBF, hepatic blood flow
  • HVPG, hepatic venous pressure gradient
  • ICG, indocyanine green
  • NOx, nitric oxide metabolites

Statistics from Altmetric.com

Footnotes

  • Published Online First 12 July 2006

  • Funding: This study was supported by grants from the Ministerio de Educación y Ciencia (BFI 2003-03858) and from the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III (C03/02, FIS04/0655 PO51419). Oscar Pastor, Rosario González, and Cristina Ripoll are recipients of grants from the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III (CM03/00041, CM04/00132 and CM03/00037).

  • Competing interests: None.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.