REDUCED GASTRIC-MUCOSAL BLOOD-FLOW IN PATIENTS WITH PORTAL-HYPERTENSIVE GASTROPATHY

Although congestive gastric mucosal circulation has been suggested in patients with portal-hypertensive gastropathy, whether it is due to '' active'' (overflow) or ''passive'' (stasis) congestion is not known. T o answer this question, we assessed regional gastric mucosal blood flo w with laser Doppler flowmetry in 57 patients with portal hypertension and 30 controls. Twelve patients had portal-hypertensive gastropathy of the antrum: in eight it was mild and in four it was severe. Portal- hypertensive gastropathy of the corpus was seen in 32 patients: it was mild in 24 and severe in 8. Thus prevalence of portal-hypertensive ga stropathy was higher in the corpus than in the antrum (p < 0.01). In t he antrum, gastric mucosal blood flow was significantly lower (p < 0.0 5) in patients with severe portal-hypertensive gastropathy (0.54 +/- 0 .27 V) than in controls (1.12 +/- 0.44 V), whereas the values in patie nts without portal-hypertensive gastropathy (0.90 +/- 0.35 V) and with mild portal-hypertensive gastropathy (0.91 +/- 0.31 V) were not signi ficantly different from the values in controls (p < 0.05 on one-way an alysis of variance). In the corpus, gastric mucosal blood flow was sig nificantly lower in patients with mild (0.75 +/- 0.25 V) or severe por tal-hypertensive gastropathy (0.42 +/- 0.22 V) than in controls (1.16 +/- 0.37 V) (p < 0.01 and p < 0.01, respectively) whereas the value in patients without portal-hypertensive gastropathy (0.99 +/- 0.37 V) wa s not significantly different from values in controls (p < 0.01 on one -way analysis of variance). We conclude that the gastric mucosa in pat ients with portal-hypertensive gastropathy (in particular, severe port al-hypertensive gastropathy) is poorly perfused. This is probably due to ''passive'' congestion. This information may have important clinica l implications in patients with portal-hypertensive gastropathy.