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

In search of an effective agent for decreasing intravariceal pressure, 27 patients with portal hypertension and large esophageal varices wer e studied. Thirteen patients received iv nitroglycerin (150-mug bolus) , and 14 received iv metoclopramide (20-mg bolus). Continuous measurem ent of variceal pressure and systemic hemodynamics was carried out. Co mpared with the baseline, the variceal pressure was significantly redu ced 10 min after nitroglycerin injection (20.23 +/- 3.1 vs. 14.6 +/- 4 .8 mm Hg, p < 0.05): the percentage reduction was 27 +/- 25.4%. With m etoclopramide, variceal pressure decreased by 12.7 +/- 22%; from 21.9 +/- 5.6 to 19.1 +/- 7.7 mmHg (p = NS). There was no significant altera tion in the heart rate and mean arterial pressure with either drug. Ou r results thus suggest that in the dosages used, intravenous nitroglyc erin effectively and safely reduces the variceal pressure. Further stu dies using a combination of nitroglycerin and metoclopramide need to b e considered.