In response to Helmy’s comments in his recent letter (Gut 2004;53:470–1), we wish to emphasise the following points, many of which were clearly stated in our original paper.¹

In agreement with the comments on “generalised vasodilatation” in cirrhosis, we made it clear that basal forearm blood flow was normal in our patient cohort despite the presence of a vasodilated circulation, as evidenced by a reduced systemic vascular resistance index. As pointed out in our paper, this observation is consistent with findings of previous studies and suggests that beds other than the forearm circulation, such as those of the splanchnic and pulmonary circulation, were dilated in our patients.

With regard to the issues raised …