Influence of esophageal varices and spontaneous portal-systemic shunts on postprandial splanchnic hemodynamics

OBJECTIVE: The aim of the study was to assess postprandial splanchnic hemod ynamic changes in cirrhosis in relation to variceal status. METHODS: In 9 healthy controls and 56 patients with liver cirrhosis, strati fied according to variceal status and presence of spontaneous portal-system ic shunts, the portal vein diameter and flow velocity, the congestion index of the portal vein, and the resistive index of the superior mesenteric art ery (SMA-RI) were studied by Doppler ultrasound before and 30, 60, and 120 min after the intake of a standard meal. Comparison of postprandial paramet ers with basal ones was done within each group by paired t test and among g roups by ANOVA and Duncan test. RESULTS: Healthy controls and cirrhotic patients without varices showed sim ilar significant splanchnic hemodynamic changes, namely a reduction of SMA- RI (-13% at 30 min) and a consequent increase in portal vein diameter (resp ectively, + 32% and + 17% in the two groups) and velocity (+66% and + 51%). A significant reduction of SMA-RI was also found in patients with varices, irrespective of the variceal size (range, -7 to -11%), but the expected po rtal vein dilation and velocity increase were progressively blunted with th e increase of variceal size (range, 0-5% for diameter and 5-19% for velocit y). Patients with spontaneous portal-systemic shunts showed a response simi lar to that of patients with large varices. Significant modification of the congestion index of the portal vein did not occur in any group. CONCLUSIONS: Our results show that the hemodynamic response to meal in pati ents with liver cirrhosis is influenced by the presence and size of esophag eal varices and the presence of spontaneous portal-systemic shunts.