EFFECTS OF INTRAVENOUS NITROGLYCERIN AND NITROGLYCERIN AND METOCLOPRAMIDE ON INTRAVARICEAL PRESSURE - A DOUBLE-BLIND, RANDOMIZED STUDY

Objective: Effective and safe reduction of variceal pressure by pharma cological means, Methods: Twenty patients with portal hypertension and large esophageal varices. Ten patients received i.v. nitroglycerin (3 00 mu g-bolus) and an equal number received a combination of i.v. nitr oglycerin (150 mu g) and metoclopramide (20-mg bolus), Continuous meas urement of variceal pressure and systemic hemodynamics was carried out . Results: Compared with the baseline, the variceal pressure was reduc ed at 10 min after injection of 300 mu g nitroglycerin (22.3 +/- 7.9 v s, 17.3 +/- 7 mm Hg, p, not significant); the percentage reduction was 23.5 +/- 15.8%. With the combination of low dose (150 mu g) nitroglyc erin and metoclopramide, variceal pressure significantly decreased fro m 23.1 +/- 4.7 to 15.9 +/- 5.9 mm Hg (p < 0.01) (a reduction of 29.5 /- 24.1%), There was no significant alteration in the heart rate or me an arterial pressure with either regimen, Conclusions: Our results sug gest that a combination of i.v. metoclopramide and low-dose nitroglyce rin reduces variceal pressure more effectively than high-dose nitrogly cerin used alone, This combination should be further evaluated in the control of acute variceal bleeding.