[Comparative study of propranolol versus propranolol plus isosorbide 5-mononitrate in portal hypertension in cirrhotics. Evaluating splanchnic hemodynamics with color Doppler ultrasound].
BACKGROUND
Hemorragic portal hypertension (HTP-H) has a mortality of 30-40%. Propranolol alone or in combination with isosorbide-5-mononitrate (5MNI) has been wed as hemorrhage preventive treatment.


OBJECTIVE
Compare propranolol vs. propranolol and 5MNI as preventive treatment of HTP-H, evaluating splachnic hemodynamics by color Doppler ultrasound (EDC).


METHODS
We included 20 patients with liver cirrhosis, mean age 53.3 years, 13 female, 10 for primary prevention and assigned them in to 2 groups treatment: l.- Propranolol alone (10 patients), ll.- Propranolol + 5-MNI (10 patients). We carried out EDC to each patient before iniciating and 2 months after treatment.


RESULTS
A decrease in splachnic hemodynamics was found in both groups as measured by portal vein (PV), hepatic artery (HA) velocity and flux decreased in group I were: PV velocity from 15.4 to 12.5 cm/seg (p = 0.019089 ) and flux from 1639.8 to 1396.8 mL/min (p = 0.031082), HA velocity from 50.1 to 44.5 cm/seg (p = 0.120385), and flux 547.1 a 470 mL/min (p = 0.069642); in group 11: PV from 16.6 to 12.9 (p = 0.019699) and from 1,786.8 to 1,304.2 (p = 0.004072), in HA from 52.3 to 44.4 (p = 0.003498 ) and 612.5 to 448.8 (p = 0.000285).


CONCLUSIONS
Propranolol and 5-MNI decreases splachnic flux and velocity more than propranolol alone, in consequence it should be better to prevent bleeding from portal hypertension.
Sánchez del Monte
Julio
J
Adscrito al Servicio de Endoscopia Gastrointestinal del INCan, ISSSTE, México. D.F. sanzdemont@yahoo.com.mx
Ramos Gómez
Mayra Virginia
MV
Velazquez Ochoa
Elvira
E
D000959:Antihypertensive Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control*; D007548:Isosorbide Dinitrate / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000008:administration & dosage*; D013152:Splanchnic Circulation; D018615:Ultrasonography, Doppler, Color; D014665:Vasodilator Agents / Q000008:administration & dosage*
D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D011433:Propranolol; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate