M. Ohta et al., PORTAL AND GASTRIC-MUCOSAL HEMODYNAMICS IN CIRRHOTIC-PATIENTS WITH PORTAL-HYPERTENSIVE GASTROPATHY, Hepatology, 20(6), 1994, pp. 1432-1436
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.