Direct measurement of post-prandial portal haemodynamics in cirrhotic patients with a transjugular intrahepatic portosystemic stent-shunt

Stanley, A. J. , Forrest, E. H., Redhead, D. N., Bouchier, I. A.D. and Hayes, P. C. (1998) Direct measurement of post-prandial portal haemodynamics in cirrhotic patients with a transjugular intrahepatic portosystemic stent-shunt. European Journal of Gastroenterology and Hepatology, 10(5), pp. 393-397. (PMID:9619385)

Abstract

Objective: Portal haemodynamics vary in response to eating and other stimuli, but any increase in portal venous pressure (PVP) in cirrhotic patients may be a risk factor for variceal bleeding. We directly assessed postprandial splanchnic haemodynamics in cirrhotic patients with a transjugular intrahepatic portosystemic stent-shunt (TIPSS) in situ. Methods: A thermodilution catheter was inserted via the patent TIPSS into the portal vein in 12 cirrhotic patients. PVP, portal venous flow (PVF) (thermodilution method), portal vascular resistance (PVR), porto-atrial pressure gradient (PPG), heart rate, mean arterial pressure (MAP) and right atrial pressure (RAP) were measured. A 505 kcal meal was given and all haemodynamic measurements were repeated at 15 min intervals for 60 min. Results: Following the meal, there was a significant rise in PVP from 11.2 ± 1.5 to 14.0 ± 1.9 mmHg at 15 min, and 14.0 ± 1.8 mmHg at 30 min (P< 0.001); in PPG from 9.5 ± 1.4 to 12.7 ± 2.2 mmHg at 15 min and 12.7 ± 2.1 mmHg at 30 min (P < 0.005); and in PVF from 1110.2 ± 141.1 to 1543.2 ± 227.6 ml/min at 30 min (P< 0.01). PVR fell from 0.08 ± 0.01 to 0.05 ± 0.01 RU at 30 min (P < 0.05). Heart rate increased from 77 ± 4.1 to 80.5 ± 5.4 bpm at 15 min (P< 0.05), but MAP and RAP remained unchanged. Conclusion: In cirrhotic patients with TIPSS, significant changes in portal haemodynamics occur at 15–30 min following a meal, with minimal effect on systemic haemodynamics. This model offers a new technique to directly assess the causes for and possible treatments of post-prandial splanchnic hyperaemia in cirrhosis.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Stanley, Dr Adrian and Forrest, Dr Ewan
• Authors: Stanley, A. J., Forrest, E. H., Redhead, D. N., Bouchier, I. A.D., and Hayes, P. C.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: European Journal of Gastroenterology and Hepatology
• Publisher: Lippincott, Williams & Wilkins
• ISSN: 0954-691X
• ISSN (Online): 1473-5687