Captoril reduced portal pressure in cirrhotic patients with low portal venous velocity

Category 2: Cirrhosis and its complications, patients and increased in 3 cases treated with octreotide.We also observed a decrease of portal flux in both groups. Conclusions: 1. Therlipressine and octreotide in slow infusion may improve the levels of creatinin and of diuresis in patients with hepato-renal syndrome.2. The effect of therapy may persist for a long period in a subgroup of patients with HRS.

pathophysiology

and clinical aspects

Conclusions: We conclude that captopril administration reduces portal pressure effectively in cirrhotic patients with low PVV. This suggests that captopril decreases intrahepatic vascular resistance and then improves portal venous outflow, and finally results in a reduction of portal pressure.

I

162

PORTAL VEIN THROMBOSIS CARCINOMA:

I 160

COMPLIANCE

OF CIRRHOTIC

PATIENTS WITH

SPONTANEOUS

BACTERIAL

PERITONITIS

PROPHYLACYIC

ANTIBIOTIC

THERAPY

DISORDER

TO

H. Alkim’,

London,

UK; ‘Asuit University, Egypt; 4Mansoura

University, Egypt;

5Ein Shams University, Egypt; 6Cairo University, Egypt

Background: Spontaneous bacterial peritonitis (SBP)represents,an important cause of morbidity and mortality in patients with hepatic cirrhosis(HC). It has been established that prophylactic antibiotic therapy significantly reduces the development of SBP in patients with HC and prior SBP episode. Aim: This study was design to evaluate the compliance of SBP patients to profilactic antimicrobial therapy and the efficacy of this regimen on the PBS recurrence. Methods: 106 patients diagnosed in our unit with HC and SBP,who received an indication for prophylactic antibiotic therapy according to conventional guidelines, had been followed at 3 month interval for 18 months. Patients who did not complete 2 consecutive examinations were excluded, so 84 patients were enrolled in the study. Results: 59 out of 84 patients (58 males and 26 females mean age 5.5 years, range 16 to 76; Child Pugh classification A:B:C=1:34:49;etiology: viral 37 pts., alcoholic 19 pts., and mixed 28 pts.)were compliant to prophylactic antimicrobial therapy (compliance 70.2%). At subsequent examinations only 10 (16.95%) compliant patients presented SBP (6 neutrocytic ascites and 4 positive cultures); out of 25 noncompliant pts., 17 (68%) presented SBP (15 neutrocytic ascites and 2 with positive cultures); p=O.OOOOl(Fisher Exact Test, Yates Corrected). Conclusion: Patients compliance with prophylactic therapy plays a major role in the recurrence of subsequent SBP episodes.

I

161

CAPTOPRIL

REDUCED

PORTAL PRESSURE

PATIENTS WITH LOW PORTAL VENOUS

IN CIRRHOTIC

VELOCITY

A.R. Abulfutuh’, M.A. Morsy2, A.M. Solyman3, S.M. El Hendawy4, M.E. El Desouky4, S.M. ElHadad5, M.M. Kame16. ‘Mansoura International London,

Hospital, Mansoura,

Egypt; 2Kings Collague

UK; ‘Asuit University, Egypt; 4Mansoura

Egypt; ‘Ein Shams University, Mansoura,

Hospital,

University, Mansoura,

Egypt; 6Cairo University, Egypt

Background/Aims: The effect of angiotensin blockade in lowering portal pressure is still controversial in patients with liver cirrhosis. We conducted this prospective study to identify (1) whether a reduction in portal pressure occurs after captopril administration, and (2)factors that contribute to the effective reduction of portal pressure in patients with cirrhosis. Methods: A total of 30 cirrhotic patients with severe esophageal varices were selected. Hepatic venous pressure gradient (HVPG)and portal venous velocity (PVV) by Doppler ultrasonography were measured before, and 3 months after captopril administration (75 mg/day). Patients who showed more than 20% reduction in HVPG after captopril administration were defined as responder. Results: HVPG changed from 15.6 mmHg to 14.0 mmHg after captopril administration (p=O.202). Nine patients (30%) were classified as responder with a successful reduction of HVPG. In multivariate analysis with parameters including age, Child-Pugh score, HVPG and PVV, only low PVV was a significant independent factor for responder (PVV < 12 cm/s; OR: 23.1, CI: 1.65-323.16).

IN HEPATOCELLULAR

RELATED

OR A COAGULATION

OR BOTH

Department,

Turkey; 2Hematology Ankara,

TUMOR

S. Ayaz2, N. Sasmaz’,

‘Gastroenterology

A.R. Abulfutuh’, M.A. Morsy2, A.M. Solyman3, S.M. El Hendawy4, M.E. El Desouky4, S.M. ElHadad5, M.M. Kame16. ‘Mansoura International Hospital, Mansoura, Egypt; 2Kings Collague Hospital,

53

l? Oguz’,

B. Sahin’.

Turkey High Speciality Hospital, Ankara,

Department,

Turkey High Speciality Hospital,

Turkey

Background: PVT is rare in intrahepatic cholangiocarcinoma (CC) and metastatic liver tumors (MLT), but common in HCC. Invasion of portal veins by hepatoma cells was considered as the main reason of PVT. Aim: To determine if there is any relation between coagulation disorders and PVT in HCC. Methods: Platelet counts, FT, aFTT, thrombin time (TT), fibrinogen, ddimer, FDP, protein-C, protein-S, antithrombin, plasminogen, a-2 antiplasmin, coagulation factors (CF) 5, 7, 8, 9, 11 and 13, vWF, prothrombin fragment 1+2 (PF1+2), tPA and PAI- were studied in 11 patients with HCC (6 with PVT), 10 healthy control, 10 CC, 10 MLT, 10 cirrhosis with PVT and 43 cirrhosis without PVT (Child-Pugh Class: 13 A, 17 B, 13 C). Results: Platelet, antithrombin, protein-C, plasminogen and CF 5, 7, 9, 11 and 13 levels of HCC group was lower and FT, aFTT, TT, vWF, FDP, PF1+2, tPA and PAI- levels was higher than control group. When compared with CC, fibrinogen, antithrombin, plasminogen and CF 5, 7, 8, 9 and 11 was lower in HCC and TT was higher. Similar differences were present between HCC and MLT groups. The results of Child-Pugh-B group were similar with HCC group. Protein-C, antithrombin, plasminogen and CF 5, 7 and 9 levels of HCC group were lower and tPA was higher than Child-Pugh-A group. Fibrinogen, antithrombin and CF 7 and 13 levels of Child-Pugh-C group were lower than HCC group and F”I and aFTT levels were higher. The findings of cirrhosis patients having PVT were identical with the HCC patients. Conclusion: Coagulation abnormalities are related with PVT seen in HCC or cirrhosis.

I

163

IS OCTREOTIDE VARICEAL

EFFECTIVE

IN THE CONTROL

OF ACUTE

BLEEDING?

S.K. Baik’, Y.J. Choi’, K.T. Suk’, J.M. Kim’, H.S. Kim’, D.K. Lee’, S.O. Kwon’, Y.J. Kim2. ‘Internal Medicine, Wonju College OfMedicine, Yonsei University, Wonju, South Korea; 2Radiology, Medicine,

Wonju College Of

Yonsei University, Wonju, South Korea

Backgrounds & Aims: Octreotide has been widely used in variceal bleeding, but the effects of octreotide on portal hemodynamics in patient with cirrhosis are still controversial. we conducted this prospective study to investigate the effects of octreotide on portal pressure and flow in cirrhotic patients with portal hypertension and thereby to determine the value of octreotide in the control of variceal bleeding. Methods: Hepatic venous pressure gradient (HVPG) and portal venous flow (PVF) were measured in 17 cirrhotic patients at baseline and 1, 5, 10, 15, 20, 30 minute after a loo-? octreotide bolus followed by continuous infusion of 25O?/h. Results: At. 1 minute, octreotide caused a marked decrease in HVPG (-45.4 & 4.7%, pO.O5). Conclusions: Octreotide induced a transient reduction in portal pressure and portal venous flow. The major pharmacological action of octreotide in the therapy of varceal bleeding is a result of its portal hypotensive effect