The extent of the collateral circulation influences the postprandial increase in portal pressure in patients with cirrhosis.
BACKGROUND
In cirrhosis, repeated flares of portal pressure and collateral blood flow provoked by postprandial hyperaemia may contribute to variceal dilation and rupture.


OBJECTIVE
To examine the effect of the extent of the collateral circulation on the postprandial increase in portal pressure observed in cirrhosis.


METHODS
The hepatic venous pressure gradient (HVPG), hepatic blood flow and azygos blood flow were measured in 64 patients with cirrhosis before and after a standard liquid meal.


RESULTS
Peak increases in HVPG (median+14.9%), hepatic blood flow (median+25.4%), and azygos blood flow (median+32.2%) occurred at 30 min after the meal. Compared with patients with marked postprandial increase in HVPG (above the median, n = 32), those showing mild (<15%, n = 32) increase in HVPG had a higher baseline azygos flow (p<0.01) and underwent a greater postprandial increase in azygos flow (p<0.02). Hepatic blood flow increased similarly in both groups. Postprandial increases in HVPG were inversely correlated (p<0.001) with both baseline azygos flow (r = -0.69) and its postprandial increase (r = -0.72). Food intake increased nitric oxide products in the azygos (p<0.01), but not in the hepatic vein. Large varices (p<0.01) and previous variceal bleeding (p<0.001) were more frequent in patients with mild increase in HVPG.


CONCLUSIONS
Postprandial hyperaemia simultaneously increases HVPG and collateral flow. The extent of the collateral circulation determines the HVPG response to food intake. Patients with extensive collateralisation show less pronounced postprandial increases in HVPG, but associated with marked flares in collateral flow. Collateral vessels preserve their ability to dilate in response to increased blood flow.
Albillos
Agustín
A
Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain. aalbillosm@meditex.es
Bañares
Rafael
R
González
Mónica
M
Catalina
Maria-Vega
MV
Pastor
Oscar
O
Gonzalez
Rosario
R
Ripoll
Cristina
C
Bosch
Jaime
J
D000328:Adult; D000368:Aged; D001401:Azygos Vein / Q000503:physiopathology; D003097:Collateral Circulation / Q000502:physiology*; D004435:Eating / Q000502:physiology; D005260:Female; D006503:Hepatic Veins / Q000503:physiopathology; D006801:Humans; D006940:Hyperemia / Q000097:blood / Q000150:complications / Q000503:physiopathology; D008102:Liver Circulation / Q000502:physiology; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009589:Nitrogen Oxides / Q000097:blood; D017082:Portal Pressure / Q000502:physiology*; D019518:Postprandial Period / Q000502:physiology*
D009589:Nitrogen Oxides