Terlipressin is more effective in deceasing variceal pressure than portal pressure in cirrhotic patients

Background/Aims: Terlipressin decreases portal pressure. However, its effec ts on variceal pressure have been poorly investigated, This study investiga ted the variceal, splanchnic and systemic hemodynamic effects of terlipress in. Methods: Twenty cirrhotic patients with esophageal varices grade II-III, an d portal pressure greater than or equal to 12 mmHg were studied. Hepatic ve nous pressure gradient, variceal pressure and systemic hemodynamic paramete rs were obtained. After baseline measurements, in a double-blind administra tion, 14 patients received a 2-mg/iv injection of terlipressin and six pati ents received placebo. The same measurements were repeated 60 min later. Results: No demographic or biochemical differences were observed in basal c ondition between groups. Terlipressin produced significant decreases in int ravariceal pressure from 20.9+/-4.9 to 16.3+/-4.7 mmHg (p<0.01, -21+/-16%), variceal pressure gradient from 18.9+/-4.8 to 13.5+/-6.0 mmHg (p<0.01, -28 +/-27%), estimated variceal wall tension from 78+/-29 to 59+/-31 mmHg.mm (p <0.01, -27+/-22%), and hepatic venous pressure gradient from 19.4+/-4.5 to 16.8+/-5 mmHg (p<0.01, -14+/-12%) at 60 min. The change in variceal pressur e after 60 min of terlipressin administration was greater than the change i n wedge hepatic venous pressure: (-4.7 mmHg vs -0.5 mmHg, respectively, p<0 .0001). Terlipressin also caused significant decreases in heart rate and ca rdiac index and increases in mean arterial pressure and peripheral vascular resistance. Conclusions: Our results demonstrate that terlipressin produces significant and prolonged decreases in variceal pressure and variceal wall tension and has intrinsic effects on portal pressure and systemic hemodynamics. Varice al pressure provides a better assessment of the effects of terlipressin adm inistration on esophageal varices than hepatic venous pressure gradient.