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.
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.
Authors: Julio D Vorobioff; Marcelo Gamen; David Kravetz; Eduardo Picabea; Roberto Villavicencio; Juan Bordato; Andrés Ruf; Fernando Bessone; Gustavo Romero; Jorge Palazzi; Alicia Nicora; María Passamonti; Hugo Tanno Journal: Gastroenterology Date: 2002-04 Impact factor: 22.682
Authors: C C Chan; S S Wang; F Y Lee; F Y Chang; H C Lin; C J Chu; C T Chen; H C Huang; S D Lee Journal: Hepatology Date: 2001-04 Impact factor: 17.425
Authors: Lia Bellis; Annalisa Berzigotti; Juan G Abraldes; Eduardo Moitinho; Juan C García-Pagán; Jaime Bosch; Juan Rodés Journal: Hepatology Date: 2003-02 Impact factor: 17.425
Authors: Mercedes Fernandez; Francesco Vizzutti; Juan Carlos Garcia-Pagan; Juan Rodes; Jaime Bosch Journal: Gastroenterology Date: 2004-03 Impact factor: 22.682
Authors: Carmen Zafra; Juan G Abraldes; Juan Turnes; Annalisa Berzigotti; Mercedes Fernández; Juan C Garca-Pagán; Juan Rodés; Jaime Bosch Journal: Gastroenterology Date: 2004-03 Impact factor: 22.682
Authors: Meng Yin; Jayant A Talwalkar; Kevin J Glaser; Sudhakar K Venkatesh; Jun Chen; Armando Manduca; Richard L Ehman Journal: AJR Am J Roentgenol Date: 2011-07 Impact factor: 3.959
Authors: Annalisa Berzigotti; Andrea De Gottardi; Ranka Vukotic; Sith Siramolpiwat; Juan G Abraldes; Juan Carlos García-Pagan; Jaime Bosch Journal: PLoS One Date: 2013-03-08 Impact factor: 3.240