THE POSTPRANDIAL PORTAL FLOW IS RELATED TO THE SEVERITY OF PORTAL-HYPERTENSION AND LIVER-CIRRHOSIS

Background/Aims: Diminished postprandial portal hyperemia has been dem onstrated by echo-Doppler flowmetry in patients with liver cirrhosis, but its diagnostic role is unclear. This prospective study was therefo re undertaken in patients with varying severity of portal hypertension and degree of liver cirrhosis. Methods: Portal flowmetry was performe d in 66 patients with cirrhosis and 20 healthy volunteers during fasti ng and 30 min after ingestion of a standardized meal. Hemodynamic para meters were related to the degree of esophageal varices, variceal blee ding, portal hypertensive gastropathy and Child-Pugh score, Results: T he postprandial portal blood velocity increment was low in patients wi th esophageal varices of any degree (22-24%), compared to patients wit hout varices (49%, p<0.01) and healthy controls (65%, p<0.001), but wa s not different in patients with or without variceal bleeding (22% vs, 20%). In contrast, the congestion index (CI; ratio of portal vein cro ss-sectional area and portal blood velocity) pre-/postprandial decreas ed in the bleeding group only (CI pre/CI post 1.30+/-0.23 (no bleeding ) vs, 0.86+/-0.29 (bleeding); p<0.01), Portal hypertensive gastropathy was not related to any of the portal flow parameters, The portal bloo d velocity increment was comparable in controls (65%) and patients wit h Child-Pugh class A cirrhosis (56%), but lower in patients with class B (32%) and class C cirrhosis (15%, p<0.05 vs. class A). Also, there was no postprandial decrease in congestion index in patients with the most severe cirrhosis (p<0.01 class C vs. class A and B), Conclusions: The postprandial rise in portal flow is inversely related to the seve rity of portal hypertension and liver cirrhosis, and may be a valuable parameter with respect to the risk of variceal bleeding.