Skip to main content

Advertisement

SpringerLink
Log in

Influence of nitroglycerin on portal pressure and gastric mucosal hemodynamics in patients with cirrhosis

  • Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

We studied 30 patients with cirrhosis to determine the effect of nitroglycerin on portal and gastric mucosal hemodynamics. Systemic hemodynamics, portal venous pressure (PVP), the hemoglobin index (IHB), and the oxygen saturation index (ISO2) of the gastric mucosa were measured before and after a continuous infusion of nitroglycerin. The patients were divided into two groups according to the presence or absence of major portal-systemic collateral routes on portograms. Nitroglycerin caused a reduction in PVP in all patients. Although there was no significant difference in systemic hemodynamic changes between the two groups, the reduction in PVP in patients with major portal-systemic collaterals was significantly higher than in those without major collaterals. A nitroglycerin infusion, at a dose of 1.0μg/kg per min for 10 min, produced a reduction in both IHB (−16%,P<0.001) and ISO2 (−13%,P<0.001) in the gastric mucosa, indicating gastric mucosal ischemia secondary to splanchnic vasoconstriction. These findings suggest that the continuous infusion of nitroglycerin reduces PVP in cirrhotic patients, particularly in those with major portal-systemic collaterals, and reduces the congestion of the gastric mucosa in patients with portal hypertension.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Blei AT, O'Reilly DJ, Gottstein J. Portal-systemic shunting and the hemodynamic effects of nitroglycerin in the rat. Gastroenterology 1984;86:1428–1436.

    PubMed  CAS  Google Scholar 

  2. Kroeger RJ, Groszmann RJ. The effect of the combination of nitroglycerin and propranolol on splanchnic and systemic hemodynamics in a portal hypertensive rat model. Hepatology 1985;5:425–430.

    PubMed  CAS  Google Scholar 

  3. Iwao T, Toyonaga A, Sumino M, et al. Hemodynamic study during transdermal application of nitroglycerin tape in patients with cirrhosis. Hepatology 1991;13:124–128.

    Article  PubMed  CAS  Google Scholar 

  4. Garcia-Tsao G, Groszmann RJ. Portal hemodynamics during nitroglycerin administration in cirrhotic patients. Hepatology 1987;7:805–809.

    PubMed  CAS  Google Scholar 

  5. Notsumata K. The effects of propranolol or nitroglycerin on azygos blood flow of patients with portal hypertension (in Japanese). Jpn J Gastroenterol 1986;83:1489–1497.

    CAS  Google Scholar 

  6. Rector WG, Hossack KF, Ready JB. Nitroglycerin for portal hypertension: A controlled comparison of the hemodynamic effects of graded doses. J Hepatol 1990;10:375–380.

    Article  PubMed  Google Scholar 

  7. Groszmann RJ, Kravetz D, Bosch J, et al. Nitroglycerin improves the hemodynamic response to vasopressin in portal hypertension. Hepatology 1982;2:757–762.

    PubMed  CAS  Google Scholar 

  8. McCormack TT, Sims J, Eyre-Brook I, et al. Gastric lesions in portal hypertension: Inflammatory gastritis or congestive gastropathy? Gut 1985;26:1226–1232.

    PubMed  CAS  Google Scholar 

  9. Iwao T, Toyonaga A, Sumino M, et al. Portal hypertensive gastropathy in patients with cirrhosis. Gastroenterology 1992; 102:2060–2065.

    PubMed  CAS  Google Scholar 

  10. D'Amico G, Montalbano L, Traina M, et al. Natural history of congestive gastropathy in cirrhosis. Gastroenterology 1990; 99:1558–1564.

    PubMed  Google Scholar 

  11. Dagradi AE, Mehler R, Tan DTD, et al. Sources of upper gastrointestinal bleeding in patients with liver cirrhosis and large esophagogastric varices. Am J Gastroenterol 1970;54:458–463.

    PubMed  CAS  Google Scholar 

  12. Lebree D, Poynard T, Bernuau J, et al. A randomized controlled study of propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: A final report. Hepatology 1984;4:355–358.

    Google Scholar 

  13. Hosking SW, Kennedy HJ, Seddon I, et al. The role of propranolol in congestive gastropathy of portal hypertension. Hepatology 1987;7:437–441.

    PubMed  CAS  Google Scholar 

  14. Sato N, Kamada T, Shichiri M, et al. Measurement of hemoperfusion and oxygen sufficiency in gastric mucosa in vivo. Gastroenterology 1979;76:814–819.

    PubMed  CAS  Google Scholar 

  15. Leung FW, Morishita T, Livingston EH, et al. Reflectance spectrophotometry for the assessment of gastroduodenal mucosal perfusion. Am J Physiol 1987;252:G797-G804.

    PubMed  CAS  Google Scholar 

  16. Okuda K, Suzuki K, Musha H, et al. Percutaneous transhepatic catheterization of the portal vein for the study of portal hemodynamics and shunts. A preliminary report. Gastroenterology 1977;73:279–284.

    PubMed  CAS  Google Scholar 

  17. Ganz W, Donoso R, Marcus HS, et al. A new technique for measurement of cardiac output by thermodilution in man. Am J Cardiol 1971;27:392–396.

    Article  PubMed  CAS  Google Scholar 

  18. Sikuler E, Kravetz D, Groszmann RJ. Evolution of portal hypertension and mechanisms involved in its maintenance in a rat model. Am J Physiol 1985;248:G618–625

    PubMed  CAS  Google Scholar 

  19. Vorobioff J, Bredfeldt JE, Groszmann RJ. Hyperdynamic circulation in portal-hypertensive rat model: A primary factor for maintenance of chronic portal hypertension. Am J Physiol 1983;244:G52–57.

    PubMed  CAS  Google Scholar 

  20. Rector WG Jr. Drug therapy for portal hypertension. Ann Intern Med 1986;105:96–107.

    PubMed  Google Scholar 

  21. Quintero E, Pique JM, Bombi JA, et al. Gastric mucosal vascular ectasias causing bleeding in cirrhosis. A distinct entity associated with hypergastrinemia and low serum levels of pepsinogen I. Gastroenterology 1987;93:1054–1061.

    PubMed  CAS  Google Scholar 

  22. Murakami M, Moriga M, Miyake T, et al. Contact electrode method in hydrogen gas clearance technique: A new method for determination of regional gastric mucosal blood flow in animals and humans. Gastroenterology 1982;82:457–467.

    PubMed  CAS  Google Scholar 

  23. Kiel JW, Riedel GL, DiResta GR, et al. Gastric mucosal blood flow measured by laser-Doppler velocimetry. Am J Physiol 1985;249:G539–545.

    PubMed  CAS  Google Scholar 

  24. Adachi H. The study of gastric mucosal change and its mechanism in patients with liver cirrhosis (in Japanese). Gastroenterol Endosc 1987;29:455–471.

    Google Scholar 

  25. Shimotsuura Y, Toyonaga A, Iwao T, et al. Gastric mucosal hemodynamics in portal hypertensive gastropathy. Gastrointest Funct Reg Disturb 1990;8:61–72.

    Google Scholar 

  26. Fukuda M, Kawano A, Sato N, et al. Gastric mucosal hemodynamics and oxygen sufficiency in patients with liver cirrhosis assessed by reflectance spectrophotometry (in Japanese). Jpn J Gastroenterol 1986;83:26–32.

    CAS  Google Scholar 

  27. Leung FW, Jensen DM, Guth PH. Endoscopic demonstration that vasopressin but not propranolol produces gastric mucosal ischemia in dogs with portal hypertension. Gastrointest Endosc 1988;34:310–313.

    PubMed  CAS  Google Scholar 

  28. Moreau R, Roulot D, Braillon A, et al. Low doses of nitroglycerin failed to improve splanchnic hemodynamics in patients with cirrhosis: Evidence for an impaired cardiopulmonary baroreflex function. Hepatology 1989;10:93–97.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Second Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, 830, Kurume, Fukuoka, Japan

    Hideya Noguchi, Atsushi Toyonaga & Kyuichi Tanikawa

Authors
  1. Hideya Noguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atsushi Toyonaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyuichi Tanikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Noguchi, H., Toyonaga, A. & Tanikawa, K. Influence of nitroglycerin on portal pressure and gastric mucosal hemodynamics in patients with cirrhosis. J Gastroenterol 29, 180–188 (1994). https://doi.org/10.1007/BF02358680

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02358680

Key words

Search

Navigation