RESPONSE OF BLOOD-FLOW TO VASOPRESSIN IN THE COLLATERAL LEFT GASTRIC VEIN IN PATIENTS WITH PORTAL-HYPERTENSION

Background/Aims: A problem in pharmacotherapy for bleeding varices in portal hypertension is non-responders. The aim of this study was to el ucidate the features of hemodynamic response to vasopressin in the gas troesophageal collateral vein in patients with esophageal varices. Met hods: Flow velocity in the portal and the col lateral left gastric vei n was measured with an echo-Doppler flowmeter before and during infusi on of vasopressin, 0.2 U/min, in 41 patients with cirrhosis and esopha geal varices. Results: The decrease in flow velocity in the left gastr ic vein with vasopressin (-29 +/- 25%) was significantly smaller than that in the portal vein (-56 +/- 20%), There was no or only minimal ch ange in flow velocity in the left gastric vein in 39% of the patients, especially in those with large-size varices, In 28 patients examined by portal catheterization, changes in flow velocity in the left gastri c vein were correlated with portal pressure, and portal pressure in no n-responders was significantly higher than that in responders (non-res ponders: 363 +/- 49, responders:312 +/- 41 mmnH(2)O, p<0.05). Conclusi ons: It was concluded that hepatofugal blood flow in the gastroesophag eal collateral is not readily reduced by vasopressin, However, as the study was performed in a stable condition without variceal bleeding, w hether these hemodynamic features will apply during acute variceal ble eding in patients who are known to have a poor hemodynamic response to vasopressin remains to be elucidated. (C) Journal of Hepatology.