Postprandial splanchnic haemodynamic changes in patients with liver cirrhosis and patent paraumbilical vein.
OBJECTIVE
The haemodynamic changes induced by a meal on collateral vessels in portal hypertensive cirrhotic patients are not well characterized. We aimed to study the postprandial modifications of splanchnic circulation in patients with a patent paraumbilical vein (PUV).


METHODS
We studied 10 cirrhotic patients with patent PUV and 10 matched cirrhotic patients without PUV, by using echo colour Doppler at baseline and 15, 30 and 45 min after a standard mixed liquid meal (400 ml; 600 kcal). Calibre and blood flow velocities of the superior mesenteric artery, portal vein and PUV were obtained; congestion index of portal vein, portal blood flow, paraumbilical blood flow and effective portal liver perfusion were calculated; intrahepatic and intrasplenic arterial resistance and pulsatility indexes were recorded.


RESULTS
We observed a postprandial splanchnic hyperaemia (superior mesenteric artery and portal vein blood flow increased after the meal in both groups; ANOVA P < 0.05), with no changes of hepatic impedance. In PUV patients, PUV constricted significantly postprandially, maximally at 30 min (calibre -17.5 +/- 7.0%; P = 0.003). Intrasplenic impedance, which may reflect portal pressure, increased, maximally at 30 min (pulsatility index +22.6 +/- 27.0%; P = 0.01), and inversely correlated with PUV vasoconstriction (R = 0.75, P = 0.01). In non-PUV patients intrasplenic impedance did not change. Portal liver perfusion increased similarly in both groups.


CONCLUSIONS
PUV constricts after the meal, and this vasoconstriction is associated with an increase of splenic impedance which may indicate the postprandial increase of portal pressure observed in cirrhosis. The increase in postprandial portal liver perfusion in the PUV group is allowed by a paradox constriction of the collateral vessel.
Berzigotti
Annalisa
A
Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, Università di Bologna, Bologna, Italy.
Dapporto
Susanna
S
Angeloni
Lucia
L
Ramilli
Stefano
S
Bianchi
Giampaolo
G
Morelli
Maria Cristina
MC
Magalotti
Donatella
D
Zoli
Marco
M
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000704:Analysis of Variance; D001783:Blood Flow Velocity / Q000502:physiology; D003097:Collateral Circulation / Q000502:physiology; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006940:Hyperemia / Q000150:complications / Q000503:physiopathology; D006975:Hypertension, Portal / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000503:physiopathology; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology; D011168:Portal System / Q000503:physiopathology; D011169:Portal Vein / Q000503:physiopathology; D019518:Postprandial Period / Q000502:physiology*; D011673:Pulsatile Flow / Q000502:physiology; D013152:Splanchnic Circulation / Q000502:physiology*; D014471:Umbilical Veins / Q000503:physiopathology
D000319:Adrenergic beta-Antagonists