Hemodynamics of the left gastric vein in portal hypertension.
BACKGROUND
Esophageal varices reflect the hemodynamics of the left gastric vein, which can now be studied by Doppler ultrasonography. The purpose of this study was to elucidate the hemodynamic features of the left gastric vein in portal hypertension.


METHODS
Flow direction and velocity in the left gastric vein were examined by the pulsed Doppler flowmeter in 53 healthy adults and 216 patients with liver cirrhosis.


RESULTS
Flow direction was hepatopetal in all healthy controls, whereas it was hepatofugal in 72% of the patients with esophageal varices. In the early stage of mild esophageal varices, flow direction was still hepatopetal. However, in portal pressure > 250 mm H2O, hepatofugal flow was highly frequent (56 of 59 patients, 95%). Hepatofugal flow velocity in patients with varices was 8.5 +/- 2.5 cm/s in mild varices, 11.6 +/- 2.4 cm/s in intermediate varices, and 13.8 +/- 3.4 cm/s in marked varices. Variceal bleeding was frequent in patients with a flow velocity > 15 cm/s (7 of 14 patients, 50%). Flow velocity in the left gastric vein increased after ingestion of glucose in 43 of 56 patients with esophageal varices.


CONCLUSIONS
In portal hypertension, as the size of varices enlarged, hepatofugal blood flow in the left gastric vein increased in parallel. High flow velocity in the left gastric vein was strongly associated with variceal bleeding. Increase of blood flow after ingestion of glucose suggests postprandial increase in variceal flow.
Matsutani
S
S
First Department of Medicine, Chiba University School of Medicine, Japan.
Furuse
J
J
Ishii
H
H
Mizumoto
H
H
Kimura
K
K
Ohto
M
M
D000284:Administration, Oral; D001783:Blood Flow Velocity; D005260:Female; D005947:Glucose / Q000494:pharmacology; D006439:Hemodynamics; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012039:Regional Blood Flow / Q000187:drug effects; D013270:Stomach / Q000098:blood supply*; D014463:Ultrasonography; D014680:Veins / Q000000981:diagnostic imaging / Q000503:physiopathology
D005947:Glucose