Clinical usefulness of the angiotensin II receptor antagonist losartan in patients with portal hypertensive gastropathy.
OBJECTIVE
An elevated portal vein pressure is an important factor in the onset of portal hypertensive gastropathy associated with liver cirrhosis, and propranolol or vasopressin (drugs with a portal hypotensive effect) are used to treat this problem. It has been reported that angiotensin II receptor antagonists, which were developed as antihypertensive agents, also have a portal hypotensive effect, but their usefulness for portal hypertensive gastropathy is unclear. In this study, the angiotensin II receptor antagonist losartan was administered to 16 portal hypertensive gastropathy patients, and its clinical usefulness was examined.


METHODS
Losartan was administered once a day after breakfast at a dose of 25mg or 50mg. The effect on portal hypertensive gastropathy was evaluated from the endoscopic findings at baseline and after 4 weeks of administration. And changes of portal hemodynamics were monitored by pulse Doppler ultrasonography at baseline and after 4 weeks of administration.


RESULTS
Portal hypertensive gastropathy was found to have improved in nine out of 16 patients for an efficacy rate of 56%. The efficacy rate in the 50mg group (n=6) was 83%, and was higher than the rate of 40% in the 25mg group (n = 10). The mean portal vein blood flow velocity was found to increase significantly, while the congestion index decreased significantly, supporting evidence of a decrease in portal pressure.


CONCLUSIONS
Losartan may become one of the effective treatments for portal hypertensive gastropathy in the future.
Wagatsuma
Yoshihisa
Y
Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Naritaka
Yoshihiko
Y
Shimakawa
Takeshi
T
Kanako
Hamaguchi
H
Keiichiro
Ishibashi
I
Shunichi
Shiozawa
S
Konno
Soichi
S
Katsube
Takao
T
Ogawa
Kernji
K
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000627:therapeutic use*; D001783:Blood Flow Velocity / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D019808:Losartan / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology; D012720:Severity of Illness Index; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D019808:Losartan