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Please use this identifier to cite or link to this item: http://hdl.handle.net/2445/18666

Title: The extent of the collateral circulation influences the postprandial increase in portal pressure in patients with cirrhosis.
Authors: Albillos, Agustín
Bañares, Rafael
González, Mónica
Catalina, María-Vega
Pastor, Oscar
González, Rosario
Ripoll, Cristina
Bosch i Genover, Jaume
Matèria: Cirrosi hepàtica
Hipertensió portal
Hepatic cirrhosis
Portal hypertension
Issue Date: 2007
Publisher: BMJ Group
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.
Nota: Reproducció digital del document publicat a: http://dx.doi.org/10.1136/gut.2006.095240
És part de: Gut, 2007, vol. 56, núm. 2, p. 259-264
URI: http://hdl.handle.net/2445/18666
ISSN: 0017-5749
Appears in Collections:Articles publicats en revistes (Medicina)

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