Effects of propranolol on gastric mucosal perfusion in cirrhotic patients with portal hypertensive gastropathy

✍ Scribed by Julián Panés; Josep M. Bordas; Josep M. Piqué; Juan C. García-pagán; Faust Feu; Josep Terés; Jaime Bosch; Joan Rodés

• Publisher: John Wiley and Sons
• Year: 1993
• Tongue: English
• Weight: 644 KB
• Volume: 17
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.1840170209

✦ Synopsis

This study investigated the effects of the short-term administration of propranolol on gastric blood perfusion in cirrhotic patients with portal hypertensive gastropathy. Portal hypertensive gastropathy is a common cause of nonvariceal bleeding in cirrhosis, which is associated with increased gastric mucosal perfusion and is favorably influenced by propranolol therapy. Gastric mucosal perfusion was evaluated with laser-Doppler flowmetry and reflectance spectrophotometry. Measurements were performed under basal conditions and after the double-blind administration of propranolol (0.15 mgbg intravenously) or placebo. Propranolol administration significantly reduced (p < 0.001) the laser-Doppler signal (2.93 -C 0.23 vs. 2.25 -C 0.22 V) and the hemoglobin content of the gastric mucosa (99.2 k 3.8 vs. 89.3 -C 3.1 arbitrary units), whereas the oxygen content remained unchanged (37.4 -+ 1.2 vs. 36.9 * 1.0 arbitrary units).

Placebo administration had no effect in any of these parameters. Changes in gastric perfusion after propranolol administration were associated with a significant decrease in hepatic venous pressure gradient and azygos blood flow. We conclude that short-term propranolol administration, in addition to lowering portal pressure, reduces the increased gastric blood perfusion in cirrhotic patients with portal hypertensive gastropathy, an effect that may contribute to prevention of bleeding from these lesions. (HEPATOLOGY 1993; 17:2 13-

218.)

Clinical studies have suggested that propranolol may be an effective therapy for bleeding from portal hypertensive gastropathy (PHG) (1-3). Propranolol has been shown to reduce portal venous pressure (4) and portocollateral blood flow in patients with cirrhosis (5). Experimental studies have further demonstrated that in portal hypertensive rats propranolol decreases gastric blood flow, which is increased in chronic portal hyper-