Comparison of gastric mucosal blood flow in normal subjects and in patients with portal hypertension using endoscopic laser-Doppler velocimetry.
OBJECTIVE
To compare gastric mucosal blood flow (GMBF) in normal subjects with that in patients with portal hypertension with or without portal hypertensive gastropathy (PHG).


METHODS
GMBF was measured by endoscopic laser-Doppler velocimetry in 20 gastroscopically normal subjects and 30 patients with portal hypertension with or without PHG. The effects of breath-holding (vasomotor reflex), submucosal epinephrine and sublingual isosorbide dinitrate were also studied.


RESULTS
In normal subjects, GMBF on the greater curvature was (mean +/- SD) 9.5 +/- 1.3 V and on the lesser curvature, 9.1 +/- 1.9 V. Breath-holding caused a reduction in GMBF by 57.1 +/- 13.7%, submucosal epinephrine reduced it by 41.5 +/- 21.5% and sublingual isosorbide caused a rise of 25.8 +/- 15.2%. The GMBF on the greater and lesser curvature respectively in patients with mild PHG (7.7 +/- 1.2 V and 7.7 +/- 0.8 V) and those with severe PHG (6.5 +/- 3.5 V and 6.3 +/- 2.2 V), was significantly less than that in normal subjects (p < 0.05 and p < 0.001 respectively). Vasomotor reflex was blunted in patients with mild and severe PHG (23.3% +/- 20.3 and 23.1% +/- 17.7 respectively, p < 0.001). Responses to submucosal epinephrine and sublingual isosorbide were similar to those recorded in normal subjects.


CONCLUSIONS
Patients with portal hypertension have significantly reduced GMBF and significantly attenuated vasomotor reflex in the gastric vascular bed as compared to normal subjects.
Sawant
P
P
Department of Gastroenterology, Lokmanya Tilak Municipal Medical College & Hospital, Sion, Bombay.
Bhatia
R
R
Kulhalli
P M
PM
Mahajani
S S
SS
Nanivadekar
S A
SA
D000328:Adult; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D004837:Epinephrine; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology*; D007548:Isosorbide Dinitrate; D017078:Laser-Doppler Flowmetry; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D013272:Stomach Diseases / Q000209:etiology / Q000503:physiopathology*; D014666:Vasomotor System / Q000187:drug effects / Q000503:physiopathology
D007548:Isosorbide Dinitrate; D004837:Epinephrine