PORTAL AND GASTRIC-MUCOSAL HEMODYNAMICS IN CIRRHOTIC-PATIENTS WITH PORTAL-HYPERTENSIVE GASTROPATHY

Controversy exists as to the nature of gastric perfusion in portal-hyp ertensive gastropathy. To investigate portal hemodynamics and gastric mucosal perfusion in cirrhotic patients with and without portal-hypert ensive gastropathy; we subjected 56 cirrhotic patients with portal hyp ertension to portal vein catheterization, pneumatic pressure sensor te chnique, duplex sonography and laser Doppler flowmetry. Thirteen patie nts had portal-hypertensive gastropathy: In 10 it was mild, and in 3 i t was severe. The presence of portal-hypertensive gastropathy seemed t o be independent of age, sex, cause of cirrhosis or grade of esophagea l varices. Portal venous pressure, esophageal variceal pressure, porta l venous how and congestion index in patients with portal-hypertensive gastropathy were not signficantly different from the values in those without portal-hypertensive gastropathy. However, portal-variceal pres sure gradient (subtracting esophageal variceal pressure from portal ve nous pressure) (p < 0.01) and the incidence of palisading-type esophag eal varices on portography (p < 0.05) was increased in patients with p ortal-hypertensive gastropathy significantly more than in those withou t portal-hypertensive gastropathy. In the fundus, gastric mucosal bloo d flow was significantly higher in patients with portal-hypertensive g astropathy than in those without portal-hypertensive gastropathy, wher eas in the corpus and the antrum the values were not significantly dif ferent. We suggest that the mucosa of the upper stomach in patients wi th portal-hypertensive gastropathy is congestive and highly perfused. The pathogenesis of portal-hypertensive gastropathy may be related to both congestion and hyperemia in the upper stomach.